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Karam C, Mauermann ML, Gonzalez-Duarte A, Kaku MC, Ajroud-Driss S, Brannagan TH, Polydefkis M. Diagnosis and treatment of hereditary transthyretin amyloidosis with polyneuropathy in the United States: Recommendations from a panel of experts. Muscle Nerve 2024; 69:273-287. [PMID: 38174864 DOI: 10.1002/mus.28026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 01/05/2024]
Abstract
Hereditary transthyretin (ATTRv; v for variant) amyloidosis is a rare, multisystem, progressive, and fatal disease in which polyneuropathy is a cardinal manifestation. Due to a lack of United States (US)-specific guidance on ATTRv amyloidosis with polyneuropathy, a panel of US-based expert clinicians convened to address identification, monitoring, and treatment of this disease. ATTRv amyloidosis with polyneuropathy should be suspected in unexplained progressive neuropathy, especially if associated with systemic symptoms or family history. The diagnosis is confirmed through genetic testing, biopsy, or cardiac technetium-based scintigraphy. Treatment should be initiated as soon as possible after diagnosis, with gene-silencing therapeutics recommended as a first-line option. Consensus is lacking on what represents "disease progression" during treatment; however, the aggressive natural history of this disease should be considered when evaluating the effectiveness of any therapy.
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Affiliation(s)
- Chafic Karam
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Alejandra Gonzalez-Duarte
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, New York, USA
| | - Michelle C Kaku
- Department of Neurology, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Senda Ajroud-Driss
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Thomas H Brannagan
- Department of Neurology, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Michael Polydefkis
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Trajectories of Kidney Function in Patients with ATTRv Treated with Gene Silencers. Genes (Basel) 2022; 13:genes13122236. [PMID: 36553503 PMCID: PMC9777815 DOI: 10.3390/genes13122236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/24/2022] [Accepted: 11/26/2022] [Indexed: 11/30/2022] Open
Abstract
Hereditary transthyretin amyloidosis (ATTRv; v for "variant") is the most common form of hereditary amyloidosis, with an autosomal dominant inheritance and a variable penetrance. This disease has a significant variability in clinical presentation and multiorgan involvement. While kidney involvement in early-onset ATTRv has been reported in one-third of patients, in late-onset ATTRv it has generally been considered rare. In the present study, we describe trajectories of kidney function over time before and after treatment with gene silencing therapies in a cohort of 17 ATTRv patients with different mutations, coming from Italy (nine subjects treated with inotersen and eight patients treated with patisiran). The analysis of estimated glomerular filtration rate (eGFR) slopes revealed that the average change in eGFR was 0.01 mL/min/1.73 m2 per month before initiation and -0.23 mL/min/1.73 m2 per month during follow-up for inotersen and -0.62 mL/min/1.73 m2 per month before initiation and -0.20 mL/min/1.73 m2 per month during follow-up for patisiran. In conclusion, we did not observe any significant difference either between the two groups of treatment or within-group before and after therapy, so gene-silencing therapies may be considered safe for renal function in ATTRv and are not associated with a worsening of eGFR slope.
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Du K, Chu X, Tang Y, Zhao X, Yu M, Zheng Y, Deng J, Lv H, Zhang W, Wang Z, Yuan Y, Meng L. Patterns of myelinated nerve fibers loss in transthyretin amyloid polyneuropathy and mimics. Ann Clin Transl Neurol 2022; 9:1059-1068. [PMID: 35665499 PMCID: PMC9268867 DOI: 10.1002/acn3.51599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/02/2022] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
Objective The present study was intended to analyze the characteristics of myelinated nerve fibers density (MFD) of transthyretin amyloid polyneuropathy (ATTR‐PN) and other similar neuropathies. Methods A total of 41 patients with ATTR‐PN, 58 patients of other common peripheral neuropathies, and 17 age‐and gender‐matched controls who visited the First Hospital of Peking University and performed sural nerve biopsy between June 2007 and August 2021 were included for analysis of MFD. Results Except the vasculitic neuropathy group, the total and small MFD of patients in the ATTR‐PN group were significantly lower than those of other disease groups. There was an obvious negative correlation between the total MFD and the disease course in the ATTR‐PN group. The disease course of early‐onset and late‐onset symptoms was similar, but the loss of large myelinated nerve fibers (MF) was more severe for the latter. In addition, all late‐onset and most early‐onset patients had severely reduced MFD after a 2 years' disease course. The MFD in ATTR‐PN patients was negatively correlated with Neuropathy Impairment Score (NIS) and Norfolk Quality of life‐diabetic neuropathy (Norfolk QOL‐DN) score. Conclusion MF is lost differently in ATTR‐PN and in other common peripheral neuropathies. The late‐onset and early‐onset ATTR‐PN patients have different patterns of loss of large and small MF.
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Affiliation(s)
- Kang Du
- Department of Neurology Peking University First Hospital 8 Xishiku Street, Xicheng District Beijing 100034 China
| | - Xujun Chu
- Department of Neurology Peking University First Hospital 8 Xishiku Street, Xicheng District Beijing 100034 China
| | - Yuwei Tang
- Department of Neurology Peking University First Hospital 8 Xishiku Street, Xicheng District Beijing 100034 China
| | - Xutong Zhao
- Department of Neurology Peking University First Hospital 8 Xishiku Street, Xicheng District Beijing 100034 China
| | - Meng Yu
- Department of Neurology Peking University First Hospital 8 Xishiku Street, Xicheng District Beijing 100034 China
| | - Yiming Zheng
- Department of Neurology Peking University First Hospital 8 Xishiku Street, Xicheng District Beijing 100034 China
| | - Jianwen Deng
- Department of Neurology Peking University First Hospital 8 Xishiku Street, Xicheng District Beijing 100034 China
| | - He Lv
- Department of Neurology Peking University First Hospital 8 Xishiku Street, Xicheng District Beijing 100034 China
| | - Wei Zhang
- Department of Neurology Peking University First Hospital 8 Xishiku Street, Xicheng District Beijing 100034 China
| | - Zhaoxia Wang
- Department of Neurology Peking University First Hospital 8 Xishiku Street, Xicheng District Beijing 100034 China
| | - Yun Yuan
- Department of Neurology Peking University First Hospital 8 Xishiku Street, Xicheng District Beijing 100034 China
- Beijing Key Laboratory of Neurovascular Disease Discovery Beijing 100034 China
| | - Lingchao Meng
- Department of Neurology Peking University First Hospital 8 Xishiku Street, Xicheng District Beijing 100034 China
- Beijing Key Laboratory of Neurovascular Disease Discovery Beijing 100034 China
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A compound score to screen patients with hereditary transthyretin amyloidosis. J Neurol 2022; 269:4281-4287. [PMID: 35279758 PMCID: PMC9293821 DOI: 10.1007/s00415-022-11056-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022]
Abstract
Background Hereditary transthyretin amyloidosis (ATTRv) is a rare, debilitating and fatal disease, mostly characterized by progressive axonal peripheral neuropathy. Diagnosis is still challenging and diagnostic delay in non-endemic area is about 3–4 years. The aim of this study was to arrange a clinical and electrophysiological score to select patients with axonal neuropathy that deserve screening for TTR mutation. Methods Thirty-five ATTRv patients and 55 patients with chronic idiopathic axonal polyneuropathy (CIAP) were retrospectively analyzed. Clinical and electrophysiological findings at first evaluation were collected. Based on significant results between the two groups, a compound (clinical and electrophysiological) score was arranged, and ROC analysis was performed to identify the ideal cut-off able to discriminate between the two groups. Results ATTRv patients presented a later age at onset, more frequent muscle weakness and carpal tunnel syndrome history. On the other hand, electrophysiological analysis showed that ATTRv patients had lower CMAP and SAP amplitude in all examined nerves. We arranged a compound score constituted by 7 total items, ranging from 0 to 12. ROC analysis showed an Area Under the Curve = 0.8655 and we set the cut-off ≥ 5 points to discriminate ATTRv patients with a sensitivity of 96.6% and a specificity of 63.6%. Conclusion Our study demonstrated that our compound score with cut-off ≥ 5 allows to discriminate ATTRv patients among subject affected by axonal polyneuropathy with a sensitivity > 95%. Thus, our compound score is a quick, easy and effective screening tool.
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Muscle MRI as a Useful Biomarker in Hereditary Transthyretin Amyloidosis: A Pilot Study. Genes (Basel) 2021; 12:genes12111786. [PMID: 34828392 PMCID: PMC8623476 DOI: 10.3390/genes12111786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 01/08/2023] Open
Abstract
Hereditary transthyretin amyloidosis (ATTRv, v for variant) is a severe and heterogeneous multisystem condition with a prevalent peripheral nervous system impairment, due to mutations in the transthyretin gene. Considering the introduction of different disease-modifying therapies in the last few years, a need of reliable biomarkers is emerging. In this study, we evaluated muscle MRI in a cohort of ATTRv patients in order to establish if the severity of muscle involvement correlated with disease severity. Linear regression analysis showed a significant positive correlation between the total fatty infiltration score and NIS, NIS-LL, and Norfolk, and an inverse correlation with Sudoscan registered from feet. In conclusion, we demonstrated the role of muscle MRI in ATTRv as possible disease biomarker, both for diagnostic purposes and for assessing the severity of the disease.
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Chandrashekar P, Alhuneafat L, Mannello M, Al-Rashdan L, Kim MM, Dungu J, Alexander K, Masri A. Prevalence and Outcomes of p.Val142Ile TTR Amyloidosis Cardiomyopathy: A Systematic Review. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2021; 14:e003356. [PMID: 34461737 DOI: 10.1161/circgen.121.003356] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The p.Val142Ile variant, predominantly found among people of African descent, is the most common cause of variant transthyretin amyloidosis and carriers predominantly develop a cardiomyopathy (variant transthyretin amyloidosis cardiomyopathy) phenotype. Yet, there are conflicting data on the prevalence and outcomes of p.Val142Ile variant carriers. METHODS We performed a systematic review of the prevalence and outcomes of p.Val142Ile variant transthyretin amyloidosis cardiomyopathy among subjects of African descent. We found 62 relevant articles after searching the MEDLINE databases from 1980 to 2020 that reported data for ≈150 000 subjects. RESULTS The reported worldwide prevalence of the p.Val142Ile variant is 0.3% to 1.6% in the general population. Among people of African descent, the reported prevalence from all studies ranges from 1.1% to 9.8%, but for studies with >1000 subjects, it is 3% to 3.5%. The prevalence of the p.Val142Ile variant in a region is dependent on the reported percentage of subjects who are of African descent in that region. p.Val142Ile variant transthyretin amyloidosis cardiomyopathy typically presents in the seventh to eighth decade of life and the majority of cases reported were male, with 25% to 38% diagnosed with atrial fibrillation. It was associated with a longitudinally worse quality of life and a lower adjusted survival compared with other types of transthyretin amyloidosis cardiomyopathy. CONCLUSIONS The p.Val142Ile variant is the most common variant of the transthyretin gene with most carriers being of African descent. The true penetrance is unknown but the p.Val142Ile variant is associated with increased rates of incident heart failure and portends a lower overall survival. Increased awareness could lead to earlier diagnosis and improved heart failure outcomes among those of African descent, which is of increasing importance given the advent of novel therapeutics for this disease.
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Affiliation(s)
- Pranav Chandrashekar
- Amyloidosis Center, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR (P.C., M.M., L.A.-R., M.M.K., A.M.)
| | - Laith Alhuneafat
- Department of Medicine, Allegheny General Hospital, Pittsburgh, PA (L.A.)
| | - Meghan Mannello
- Amyloidosis Center, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR (P.C., M.M., L.A.-R., M.M.K., A.M.)
| | - Lana Al-Rashdan
- Amyloidosis Center, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR (P.C., M.M., L.A.-R., M.M.K., A.M.).,Department of Medicine, Allegheny General Hospital, Pittsburgh, PA (L.A.)
| | - Morris M Kim
- Amyloidosis Center, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR (P.C., M.M., L.A.-R., M.M.K., A.M.)
| | - Jason Dungu
- Essex Cardiothoracic Center, England, United Kingdom (J.D.)
| | - Kevin Alexander
- School of Medicine, Division of Cardiology, Stanford University, Palo Alto, CA (K.A.)
| | - Ahmad Masri
- Amyloidosis Center, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR (P.C., M.M., L.A.-R., M.M.K., A.M.)
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Variable Presentation of Hereditary Transthyretin-Mediated Amyloidosis at a Single Center. J Clin Neuromuscul Dis 2021; 23:7-17. [PMID: 34431796 DOI: 10.1097/cnd.0000000000000356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Describe atypical presentations of hereditary transthyretin-mediated (hATTR) amyloidosis with polyneuropathy. METHODS Initial symptoms, diagnoses, and follow-up were recorded at the Austin Neuromuscular Center for 12 patients with nonclassical presentation of hATTR amyloidosis. RESULTS Common initial symptoms were hand and/or feet sensory manifestations (83%), muscle weakness (58%), and, less frequently, gastrointestinal and orthostatic impairment and carpal tunnel syndrome. Initial diagnoses were polyneuropathy (83%) and/or myopathy (25%). During follow-up, 10 patients (83%) developed cardiac symptoms (dyspnea, 67% and ankle edema, 17%), resulting in revised diagnoses of heart disease. Multisystem involvement raised suspicion of amyloidosis, which was confirmed by biopsy or nuclear scintigraphy, and genetic testing. All patients had polyneuropathy; 8 (67%) had cardiomyopathy-associated transthyretin mutations (V122I or T60A). Time from symptom onset to diagnosis was up to 10 years (median 5 years), during which patients' health deteriorated, although with recognition of disease signs/symptoms the diagnosis of hATTR amyloidosis was made in approximately 2-6 months from presentation at our center. CONCLUSIONS Increased awareness of the diverse initial hATTR amyloidosis symptoms could shorten time to diagnosis, enabling earlier treatment and improved patient outcomes.
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Ferraro PM, D’Ambrosio V, Di Paolantonio A, Guglielmino V, Calabresi P, Sabatelli M, Luigetti M. Renal Involvement in Hereditary Transthyretin Amyloidosis: An Italian Single-Centre Experience. Brain Sci 2021; 11:brainsci11080980. [PMID: 34439599 PMCID: PMC8394946 DOI: 10.3390/brainsci11080980] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 01/14/2023] Open
Abstract
Objective: Hereditary transthyretin amyloidosis (ATTRv) represents a diagnostic challenge considering the great variability of clinical presentation and multiorgan involvement. In the present study, we report the prevalence of kidney involvement and kidney function over time in a cohort of ATTRv patients with different transthyretin gene mutations. Patients and Methods: For this study, we systematically collected data from all patients with a diagnosis of ATTRv followed at the Neurology Unit of Fondazione Policlinico Universitario A. Gemelli IRCCS. Kidney involvement was defined as presence of estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 obtained with CKD-EPI equation, abnormal urinary protein excretion (UPE) (>150 mg/24 h) and/or albuminuria > 30 mg/24 h (or mg/g creatinine). The analysis included data from 46 patients with 122 measurements of serum creatinine. Results: Among the 46 patients included in the analysis, kidney involvement was present in 37%, with 15% showing reduced eGFR and 22% abnormal UPE (63% of patients with available UPE data). No single predictor was associated with either eGFR values or its slope over time. Conclusions: Kidney involvement is quite common in patients with ATTRv regardless of the underlying genetic variant. In particular, abnormal UPE appears to be a common feature of the disease.
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Affiliation(s)
- Pietro Manuel Ferraro
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Nefrologia, 00168 Rome, Italy; (P.M.F.); (V.D.)
- Università Cattolica del Sacro Cuore, Sede di Roma, Largo A. Gemelli 8, 00168 Roma, Italy; (A.D.P.); (V.G.); (P.C.); (M.S.)
| | - Viola D’Ambrosio
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Nefrologia, 00168 Rome, Italy; (P.M.F.); (V.D.)
- Università Cattolica del Sacro Cuore, Sede di Roma, Largo A. Gemelli 8, 00168 Roma, Italy; (A.D.P.); (V.G.); (P.C.); (M.S.)
| | - Andrea Di Paolantonio
- Università Cattolica del Sacro Cuore, Sede di Roma, Largo A. Gemelli 8, 00168 Roma, Italy; (A.D.P.); (V.G.); (P.C.); (M.S.)
| | - Valeria Guglielmino
- Università Cattolica del Sacro Cuore, Sede di Roma, Largo A. Gemelli 8, 00168 Roma, Italy; (A.D.P.); (V.G.); (P.C.); (M.S.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Neurologia, 00168 Rome, Italy
| | - Paolo Calabresi
- Università Cattolica del Sacro Cuore, Sede di Roma, Largo A. Gemelli 8, 00168 Roma, Italy; (A.D.P.); (V.G.); (P.C.); (M.S.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Neurologia, 00168 Rome, Italy
| | - Mario Sabatelli
- Università Cattolica del Sacro Cuore, Sede di Roma, Largo A. Gemelli 8, 00168 Roma, Italy; (A.D.P.); (V.G.); (P.C.); (M.S.)
- Centro Clinico NEMO Adulti, 00168 Rome, Italy
| | - Marco Luigetti
- Università Cattolica del Sacro Cuore, Sede di Roma, Largo A. Gemelli 8, 00168 Roma, Italy; (A.D.P.); (V.G.); (P.C.); (M.S.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Neurologia, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-06-3015-4435; Fax: +39-06-3550-1909
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Davion JB, Bocquillon P, Cassim F, Frezel N, Lacour A, Dhaenens CM, Maurage CA, Gibier JB, Hachulla E, Nguyen The Tich S, Defebvre L, Merle PE, Tard C. Electro-clinical presentation of hereditary transthyretin related amyloidosis when presenting as a polyneuropathy of unknown origin in northern France. Rev Neurol (Paris) 2021; 177:1160-1167. [PMID: 34253345 DOI: 10.1016/j.neurol.2021.02.392] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/22/2021] [Accepted: 02/02/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Hereditary transthyretin related amyloidosis (h-ATTR) classically presents as a small fiber neuropathy with positive family history, but can also be revealed by various other types of peripheral neuropathy. OBJECTIVE To describe the initial electro-clinical presentation of patients from in a single region (northern France) of h-ATTR when it presents as a polyneuropathy of unknown origin. METHOD We reviewed the records of patients referred to two neuromuscular centers from northern France with a peripheral neuropathy of unknown origin who were subsequently diagnosed with h-ATTR. RESULTS Among 26 h-ATTR patients (10 Val30Met, 16 Ser77Tyr), only 14 patients had a suspicious family history (53.8%). The electro-clinical presentation was mostly a large-fiber sensory motor polyneuropathy (92.3%), which could be symmetric or not, length-dependent or not, or associated with nerve entrapment or not. Demyelinating signs were observed in 17 patients (70.8%), among whom nine fulfilled the criteria for a definite diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy (37.5%). CONCLUSION h-ATTR may have a wide spectrum of clinical profiles, and should be considered in the screening of polyneuropathies of unknown origin.
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Affiliation(s)
- J-B Davion
- Centre de référence des Maladies Neuromusculaires, CHU Lille, 59000 Lille, France; Service de Neurologie pédiatrique, CHU Lille, 59000 Lille, France.
| | - P Bocquillon
- Service de Neurophysiologie clinique, CHU Lille, 59000 Lille, France
| | - F Cassim
- Service de Neurophysiologie clinique, CHU Lille, 59000 Lille, France
| | - N Frezel
- Service de Neurophysiologie clinique, CHU Lille, 59000 Lille, France
| | - A Lacour
- Service de Neurologie, CHU de Saint-Etienne, 42000 Saint-Etienne, France
| | - C-M Dhaenens
- University of Lille, Inserm UMR-S 1172, CHU Lille, Biochemistry and Molecular Biology Department - UF Génopathies, Lille, France
| | - C-A Maurage
- Service de Pathologie, CHU Lille, 59000, Lille, France
| | - J-B Gibier
- Service de Pathologie, CHU Lille, 59000, Lille, France
| | - E Hachulla
- Service de Médecine Interne et Immunologie Clinique, CHU Lille, 59000 Lille, France
| | - S Nguyen The Tich
- Centre de référence des Maladies Neuromusculaires, CHU Lille, 59000 Lille, France; Service de Neurologie pédiatrique, CHU Lille, 59000 Lille, France
| | - L Defebvre
- Service de Neurologie et pathologie du mouvement, CHU Lille, 59000 Lille, France
| | - P-E Merle
- Service des Explorations Fonctionnelles du Système Nerveux, CHU Amiens-Picardie, 80000 Amiens, France
| | - C Tard
- Centre de référence des Maladies Neuromusculaires, CHU Lille, 59000 Lille, France; Service de Neurologie et pathologie du mouvement, CHU Lille, 59000 Lille, France
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Minnella AM, Rissotto R, Maceroni M, Romano A, Fasciani R, Luigetti M, Sabatelli M, Rizzo S, Falsini B. Ocular Involvement in Hereditary Transthyretin Amyloidosis: A Case Series Describing Novel Potential Biomarkers. Genes (Basel) 2021; 12:genes12060927. [PMID: 34207092 PMCID: PMC8234990 DOI: 10.3390/genes12060927] [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: 05/30/2021] [Revised: 06/09/2021] [Accepted: 06/17/2021] [Indexed: 01/15/2023] Open
Abstract
Hereditary transthyretin amyloidosis (hATTR) is a rare disease caused by a point mutation in the transthyretin (TTR) gene and inherited in an autosomal dominant fashion. TTR is a plasma protein that functions as a carrier for thyroxine (T4) and retinol (vitamin A). Ophthalmological manifestations are due to both the hepatic and ocular production of mutated TTR. In this case series, we report the ocular manifestations of hATTR in eighteen eyes of nine consecutive patients. Corneal nerve abnormalities as well as morphological and functional changes in the retina were investigated. The study was a single-center, retrospective, observational, clinical case series. In all patients, corneal confocal microscopy (CCM), multimodal imaging of the retina, including fundus photography and Optical Coherence Tomography (OCT), as well as rod and cone electroretinography (ERG) were performed. Eight patients had active disease and one was an unaffected carrier. In all study eyes, corneal nerve plexa examined with CCM were poorly represented or absent. Mixed rod-cone and cone ERG b-wave amplitudes were reduced, and photopic b-wave responses were significantly delayed. Photopic Negative Response (PhNR) amplitude was significantly reduced, while PhNR latency was significantly augmented. In 13/18 eyes, vitreous opacities and abnormalities of vitreo-retinal interface were found. The current results highlight the presence of corneal nerve damage. Functional retinal abnormalities, detected by ERG, can be found even in the presence of minimal or absent structural retinal damage. These findings support the use of CCM and ERGs to detect early biomarkers for primary hATTR.
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Affiliation(s)
- Angelo Maria Minnella
- Institute of Ophthalmology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.M.); (R.R.); (S.R.); (B.F.)
- Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy; (R.F.); (M.L.)
| | - Roberta Rissotto
- Institute of Ophthalmology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.M.); (R.R.); (S.R.); (B.F.)
- Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy; (R.F.); (M.L.)
| | - Martina Maceroni
- Institute of Ophthalmology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.M.); (R.R.); (S.R.); (B.F.)
- Correspondence: ; Tel.: +06-301-549-2
| | - Angela Romano
- Institute of Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.R.); (M.S.)
| | - Romina Fasciani
- Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy; (R.F.); (M.L.)
| | - Marco Luigetti
- Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy; (R.F.); (M.L.)
- Institute of Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.R.); (M.S.)
| | - Mario Sabatelli
- Institute of Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.R.); (M.S.)
- Centro Clinico NEMO Adulti, Sede di Roma, 00168 Rome, Italy
| | - Stanislao Rizzo
- Institute of Ophthalmology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.M.); (R.R.); (S.R.); (B.F.)
- Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy; (R.F.); (M.L.)
| | - Benedetto Falsini
- Institute of Ophthalmology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.M.); (R.R.); (S.R.); (B.F.)
- Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy; (R.F.); (M.L.)
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ATTRv in Lazio-Italy: A High-Prevalence Region in a Non-Endemic Country. Genes (Basel) 2021; 12:genes12060829. [PMID: 34071271 PMCID: PMC8228008 DOI: 10.3390/genes12060829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 05/23/2021] [Accepted: 05/27/2021] [Indexed: 12/14/2022] Open
Abstract
Hereditary transthyretin amyloidosis (ATTRv, v for variant) prevalence in Italy, a non-endemic region, has been established by ATTRv amyloidosis Italian Registry. However, values of prevalence were extremely heterogeneous, considering different regions. To properly establish the prevalence of the disease in the Lazio region, a survey was sent to university regional hospitals and to main regional hospitals, in order to collect all affected patients regularly followed. We identified 100 ATTRv patients and, considering a Lazio population of 5.8/million, we estimated a ATTRv prevalence of 17.2/million. The ATTRv amyloidosis Italian Registry reported a prevalence of 8.0/million in Lazio, while our survey showed a value of double this. Our survey documented a high-prevalence for a non-endemic country. The increased awareness of the disease among general practitioners and medical specialists is a fundamental step to reduce the diagnostic delay and start an effective treatment of this disease.
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12
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Grandis M, Obici L, Luigetti M, Briani C, Benedicenti F, Bisogni G, Canepa M, Cappelli F, Danesino C, Fabrizi GM, Fenu S, Ferrandes G, Gemelli C, Manganelli F, Mazzeo A, Melchiorri L, Perfetto F, Pradotto LG, Rimessi P, Tini G, Tozza S, Trevisan L, Pareyson D, Mandich P. Recommendations for pre-symptomatic genetic testing for hereditary transthyretin amyloidosis in the era of effective therapy: a multicenter Italian consensus. Orphanet J Rare Dis 2020; 15:348. [PMID: 33317601 PMCID: PMC7734774 DOI: 10.1186/s13023-020-01633-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/27/2020] [Indexed: 12/13/2022] Open
Abstract
Hereditary transthyretin amyloidosis (ATTRv, v for variant) is a late-onset, autosomal dominant disease caused by progressive extracellular deposition of transthyretin amyloid fibrils, leading to organ damage and death. For other late-onset fatal diseases, as Huntington’s disease, protocols for pre-symptomatic genetic testing (PST) are available since decades. For ATTRv, limited experience has been reported to date, mostly gathered before the availability of approved therapies. We aimed at developing recommendations for a safe and feasible PST protocol in ATTRv in the era of emerging treatments, taking also into account Italian patients’ characteristics and healthcare system rules. After an initial survey on ongoing approaches to PST for ATTRv in Italy, two roundtable meetings were attended by 24 experts from 16 Italian centers involved in the diagnosis and care of this disease. Minimal requirements for PST offer and potential critical issues were highlighted. By November 2019, 457 families affected by ATTRv with 209 molecularly confirmed pre-symptomatic carriers were counted. The median age at PST was 41.3 years of age, regardless of the specific mutation. Half of the Italian centers had a multidisciplinary team, including a neurologist, an internist, a cardiologist, a medical geneticist and a psychologist, although in most cases not all the specialists were available in the same center. A variable number of visits was performed at each site. Experts agreed that PST should be offered only in the context of genetic counselling to at risk individuals aged 18 or older. Advertised commercial options for DNA testing should be avoided. The protocol should consist of several steps, including a preliminary clinical examination, a pre-test information session, an interval time, the genetic test and a post-test session with the disclosure of the test results, in the context of an experienced multidisciplinary team. Recommendations for best timing were also defined. Protocols for PST in the context of ATTRv can be refined to offer at risk individuals the best chance for early diagnosis and timely treatment start, while respecting autonomous decisions and promoting safe psychological adjustment to the genetic result.
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Affiliation(s)
- M Grandis
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), Section of Medical Genetics, University of Genoa, c/o DIMI Viale Benedetto XV, 6, 16132, Genova, Italy.,IRCCS Policlinico San Martino, Genova, Italy
| | - L Obici
- Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - M Luigetti
- UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Briani
- Department of Neuroscience, University of Padova, Padova, Italy
| | - F Benedicenti
- Medical Genetics, Azienda Sanitaria Dell'Alto Adige, Bolzano, Italy
| | - G Bisogni
- Centro Clinico Nemo Adulti-Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - M Canepa
- Cardiovascular Disease Unit, IRCCS Policlinico San Martino, Genova, and IRCCS Italian Cardiovascular Network, Department of Internal Medicine, University of Genova, Genova, Italy
| | - F Cappelli
- Tuscan Regional Amyloidosis Center, Careggi University Hospital, Firenze, Italy
| | - C Danesino
- Molecular Medicine Department, University of Pavia, Pavia, Italy
| | - G M Fabrizi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Neurology, University of Verona and University Hospital GB Rossi, Verona, Italy
| | - S Fenu
- Unit of Rare Neurodegenerative and Neurometabolic Diseases, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - G Ferrandes
- IRCCS Policlinico San Martino, Genova, Italy
| | - C Gemelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), Section of Medical Genetics, University of Genoa, c/o DIMI Viale Benedetto XV, 6, 16132, Genova, Italy.,Neuromuscular Omnicentre (NEMO)-Fondazione Serena Onlus, Arenzano, GE, Italy
| | - F Manganelli
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Napoli, Italy
| | - A Mazzeo
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - L Melchiorri
- Medical Genetics Unit, Azienda Ospedaliero Universitaria Di Ferrara, Ferrara, Italy
| | - F Perfetto
- Tuscan Regional Amyloidosis Center, Careggi University Hospital, Firenze, Italy
| | - L G Pradotto
- Department of Neurosciences, University of Turin, Torino, Italy.,Division of Neurology and Neurorehabilitazion, IRCCS Istituto Auxologico Italiano, Piancavallo, VB, Italy
| | - P Rimessi
- Medical Genetics Unit, Azienda Ospedaliero Universitaria Di Ferrara, Ferrara, Italy
| | - G Tini
- Cardiovascular Disease Unit, IRCCS Policlinico San Martino, Genova, and IRCCS Italian Cardiovascular Network, Department of Internal Medicine, University of Genova, Genova, Italy
| | - S Tozza
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Napoli, Italy
| | - L Trevisan
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), Section of Medical Genetics, University of Genoa, c/o DIMI Viale Benedetto XV, 6, 16132, Genova, Italy.,IRCCS Policlinico San Martino, Genova, Italy
| | - D Pareyson
- Unit of Rare Neurodegenerative and Neurometabolic Diseases, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - P Mandich
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), Section of Medical Genetics, University of Genoa, c/o DIMI Viale Benedetto XV, 6, 16132, Genova, Italy. .,IRCCS Policlinico San Martino, Genova, Italy.
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13
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Russo M, Obici L, Bartolomei I, Cappelli F, Luigetti M, Fenu S, Cavallaro T, Chiappini MG, Gemelli C, Pradotto LG, Manganelli F, Leonardi L, My F, Sampaolo S, Briani C, Gentile L, Stancanelli C, Di Buduo E, Pacciolla P, Salvi F, Casagrande S, Bisogni G, Calabrese D, Vanoli F, Di Iorio G, Antonini G, Santoro L, Mauro A, Grandis M, Di Girolamo M, Fabrizi GM, Pareyson D, Sabatelli M, Perfetto F, Rapezzi C, Merlini G, Mazzeo A, Vita G. ATTRv amyloidosis Italian Registry: clinical and epidemiological data. Amyloid 2020; 27:259-265. [PMID: 32696671 DOI: 10.1080/13506129.2020.1794807] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION ATTRv amyloidosis is worldwide spread with endemic foci in Portugal and Sweden, Japan, Brazil, Maiorca, and Cyprus. A national Registry was developed to characterise the epidemiology and genotype-phenotype correlation of ATTRv amyloidosis in Italy and to allow a better planning of diagnostic and therapeutic services. METHODS Fifteen Italian referral centres for amyloidosis spread all over the country have contributed to the Registry. RESULTS Four-hundred-forty-seven subjects were enrolled, 187 asymptomatic carriers and 260 affected patients. Thirty-one different mutations were recorded. The seven most represented genetic variants were significantly different in terms of age at onset, clinical features and geographical distribution. National prevalence is 4.33/million with higher values in Southern Italy. Overall symptoms of polyneuropathy were present at disease onset in about half of the patients, symptoms of cardiomyopathy in a quarter of patients, the rest referring carpal tunnel syndrome, dysautonomia or lumbar spinal stenosis. 52.6% of patients were in FAP stage 1, 20.4% in stage 2 and 13.5% in stage 3, while 13.5% patients had no neuropathy, presenting only cardiological symptoms. CONCLUSIONS We presented an epidemiological study based on collaboration among referral centres for ATTRv amyloidosis spread in all the Italian territory, using web-based Registry. It provided a detailed map of the regional distribution of the disease. The increased awareness of the disease among general practitioners and medical specialists has contributed to reduce the diagnostic delay and the rate of misdiagnosis. The Registry will allow to collect also future information about clinical and instrumental follow-up.
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Affiliation(s)
- Massimo Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Laura Obici
- IRCCS Fondazione Policlinico San Matteo, University of Pavia, Amyloidosis Research and Treatment Center, Pavia, Italy
| | | | - Francesco Cappelli
- Department of Internal and Experimental Medicine, University of Florence, Florence, Italy
| | - Marco Luigetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS. UOC Neurologia, Rome, Italy
| | - Silvia Fenu
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Tiziana Cavallaro
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Maria Grazia Chiappini
- Fatebenefratelli Foundation-'San Giovanni Calibita' Fatebenefratelli Hospital, Clinical Pathophysiology Center, Rome, Italy
| | - Chiara Gemelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Luca Guglielmo Pradotto
- San Giuseppe Hospital, IRCCS-Istituto Auxologico Italiano, Division of Neurology and Neurorehabilitation, Piancavallo, Italy.,Department of Neuroscience, University of Turin, Turin, Italy
| | - Fiore Manganelli
- Department of Neurosciences Reproductive and Odontostomatological Sciences, University Federico II, Naples, Italy
| | - Luca Leonardi
- Unit of Neuromuscular Diseases, Department of Neurology, Mental Health and Sensory Organs (NESMOS), Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Filomena My
- Division of Neurology, Ospedale V. Fazzi, Lecce, Italy
| | - Simone Sampaolo
- Second Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Chiara Briani
- Department of Neuroscience, Neurology Unit, University of Padova School of Medicine and Surgery, Padova, Italy
| | - Luca Gentile
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Claudia Stancanelli
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Eleonora Di Buduo
- IRCCS Fondazione Policlinico San Matteo, University of Pavia, Amyloidosis Research and Treatment Center, Pavia, Italy
| | - Paolo Pacciolla
- IRCCS Fondazione Policlinico San Matteo, University of Pavia, Amyloidosis Research and Treatment Center, Pavia, Italy
| | - Fabrizio Salvi
- Amyloidosis Centre, University of Bologna, Bologna, Italy
| | - Silvia Casagrande
- Department of Internal and Experimental Medicine, University of Florence, Florence, Italy
| | | | | | - Fiammetta Vanoli
- Unit of Neuromuscular Diseases, Department of Neurology, Mental Health and Sensory Organs (NESMOS), Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Giuseppe Di Iorio
- Second Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giovanni Antonini
- Unit of Neuromuscular Diseases, Department of Neurology, Mental Health and Sensory Organs (NESMOS), Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Lucio Santoro
- Department of Neurosciences Reproductive and Odontostomatological Sciences, University Federico II, Naples, Italy
| | - Alessandro Mauro
- San Giuseppe Hospital, IRCCS-Istituto Auxologico Italiano, Division of Neurology and Neurorehabilitation, Piancavallo, Italy.,Department of Neuroscience, University of Turin, Turin, Italy
| | - Marina Grandis
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Marco Di Girolamo
- Fatebenefratelli Foundation-'San Giovanni Calibita' Fatebenefratelli Hospital, Clinical Pathophysiology Center, Rome, Italy
| | - Gian Maria Fabrizi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Davide Pareyson
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Mario Sabatelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS. UOC Neurologia, Rome, Italy
| | - Federico Perfetto
- Department of Internal and Experimental Medicine, University of Florence, Florence, Italy
| | - Claudio Rapezzi
- Department of Cardiology, University of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital GVM, Care and Research, Cotignola, Italy
| | - Giampaolo Merlini
- IRCCS Fondazione Policlinico San Matteo, University of Pavia, Amyloidosis Research and Treatment Center, Pavia, Italy
| | - Anna Mazzeo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Vita
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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14
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De Lillo A, Pathak GA, De Angelis F, Di Girolamo M, Luigetti M, Sabatelli M, Perfetto F, Frusconi S, Manfellotto D, Fuciarelli M, Polimanti R. Epigenetic profiling of Italian patients identified methylation sites associated with hereditary transthyretin amyloidosis. Clin Epigenetics 2020; 12:176. [PMID: 33203445 PMCID: PMC7672937 DOI: 10.1186/s13148-020-00967-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/03/2020] [Indexed: 11/10/2022] Open
Abstract
Hereditary transthyretin (TTR) amyloidosis (hATTR) is a rare life-threatening disorder caused by amyloidogenic coding mutations located in TTR gene. To understand the high phenotypic variability observed among carriers of TTR disease-causing mutations, we conducted an epigenome-wide association study (EWAS) assessing more than 700,000 methylation sites and testing epigenetic difference of TTR coding mutation carriers vs. non-carriers. We observed a significant methylation change at cg09097335 site located in Beta-secretase 2 (BACE2) gene (standardized regression coefficient = -0.60, p = 6.26 × 10-8). This gene is involved in a protein interaction network enriched for biological processes and molecular pathways related to amyloid-beta metabolism (Gene Ontology: 0050435, q = 0.007), amyloid fiber formation (Reactome HSA-977225, q = 0.008), and Alzheimer's disease (KEGG hsa05010, q = 2.2 × 10-4). Additionally, TTR and BACE2 share APP (amyloid-beta precursor protein) as a validated protein interactor. Within TTR gene region, we observed that Val30Met disrupts a methylation site, cg13139646, causing a drastic hypomethylation in carriers of this amyloidogenic mutation (standardized regression coefficient = -2.18, p = 3.34 × 10-11). Cg13139646 showed co-methylation with cg19203115 (Pearson's r2 = 0.32), which showed significant epigenetic differences between symptomatic and asymptomatic carriers of amyloidogenic mutations (standardized regression coefficient = -0.56, p = 8.6 × 10-4). In conclusion, we provide novel insights related to the molecular mechanisms involved in the complex heterogeneity of hATTR, highlighting the role of epigenetic regulation in this rare disorder.
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Affiliation(s)
| | - Gita A Pathak
- Department of Psychiatry, Yale University School of Medicine, VA CT Healthcare Center, VA CT 116A2, 950 Campbell Avenue, West Haven, CT, USA
- VA CT Healthcare Center, West Haven, CT, USA
| | - Flavio De Angelis
- Department of Biology, University of Rome Tor Vergata, Rome, Italy
- Department of Psychiatry, Yale University School of Medicine, VA CT Healthcare Center, VA CT 116A2, 950 Campbell Avenue, West Haven, CT, USA
- VA CT Healthcare Center, West Haven, CT, USA
| | - Marco Di Girolamo
- Clinical Pathophysiology Center, Fatebenefratelli Foundation -'San Giovanni Calibita' Fatebenefratelli Hospital, Rome, Italy
| | - Marco Luigetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Neurologia, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mario Sabatelli
- Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Clinico NEMO Adulti, Rome, Italy
| | - Federico Perfetto
- Regional Amyloid Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Sabrina Frusconi
- Genetic Diagnostics Unit, Laboratory Department, Careggi University Hospital, Florence, Italy
| | - Dario Manfellotto
- Clinical Pathophysiology Center, Fatebenefratelli Foundation -'San Giovanni Calibita' Fatebenefratelli Hospital, Rome, Italy
| | - Maria Fuciarelli
- Department of Biology, University of Rome Tor Vergata, Rome, Italy
| | - Renato Polimanti
- Department of Psychiatry, Yale University School of Medicine, VA CT Healthcare Center, VA CT 116A2, 950 Campbell Avenue, West Haven, CT, USA.
- VA CT Healthcare Center, West Haven, CT, USA.
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15
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hATTR Pathology: Nerve Biopsy Results from Italian Referral Centers. Brain Sci 2020; 10:brainsci10110780. [PMID: 33114611 PMCID: PMC7692609 DOI: 10.3390/brainsci10110780] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/11/2020] [Accepted: 10/23/2020] [Indexed: 12/19/2022] Open
Abstract
Pathological evidence of amyloid on nerve biopsy has been the gold standard for diagnosis in hereditary transthyretin amyloidosis polyneuropathy (hATTR-PN) for a long time. In this article, we reviewed the pathological findings of a large series of sural nerve biopsies from a cohort of hATTR-PN patients, collected by different Italian referral centers. Patients and Methods: We reviewed clinical and pathological data from hATTR-PN patients, diagnosed and followed in five Italian referral centers for peripheral neuropathies. Diagnosis was formulated after a positive genetic test for transthyretin (TTR) mutations. Sural nerve biopsy was performed according to standard protocols. Results: Sixty-nine sural nerve biopsies from hATTR-PN patients were examined. Congo red positive deposits were found in 73% of cases. Only the Phe64Leu mutation failed to show amyloid deposits in a high percentage of biopsies (54%), as already described. Unusual pathological findings, such as myelin abnormalities or inflammatory infiltrates, were detected in occasional cases. Conclusions: Even if no longer indicated to confirm hATTR-PN clinical suspicion, nerve biopsy remains, in expert hands, a rapid and inexpensive tool to detect amyloid deposition. In Italy, clinicians should be aware that a negative biopsy does not exclude hATTR-PN, particularly for Phe64Leu, one of the most frequent mutations in this country.
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16
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Luigetti M, Romano A, Di Paolantonio A, Bisogni G, Sabatelli M. Diagnosis and Treatment of Hereditary Transthyretin Amyloidosis (hATTR) Polyneuropathy: Current Perspectives on Improving Patient Care. Ther Clin Risk Manag 2020; 16:109-123. [PMID: 32110029 PMCID: PMC7041433 DOI: 10.2147/tcrm.s219979] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 01/27/2020] [Indexed: 12/16/2022] Open
Abstract
Hereditary transthyretin amyloidosis (hATTR) with polyneuropathy (formerly known as Familial Amyloid Polyneuropathy) is a rare disease due to mutations in the gene encoding transthyretin (TTR) and characterized by multisystem extracellular deposition of amyloid, leading to dysfunction of different organs and tissues. hATTR amyloidosis represents a diagnostic challenge for neurologists considering the great variability in clinical presentation and multiorgan involvement. Generally, patients present with polyneuropathy, but clinicians should consider the frequent cardiac, ocular and renal impairment. Especially a hypertrophic cardiomyopathy, even if usually latent, is identifiable in at least 50% of the patients. Therapeutically, current available options act at different stages of TTR production, including synthesis inhibition (liver transplantation and/or gene-silencing drugs) or tetramer TTR stabilization (TTR stabilizers), increasing survival at different disease stages. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/n8sg_YlGJiA
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Affiliation(s)
- Marco Luigetti
- Neurology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | | | - Mario Sabatelli
- Università Cattolica del Sacro Cuore, Rome, Italy.,Centro Clinico NEMO Adulti, Rome, Italy
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17
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Campagnolo M, Taioli F, Cacciavillani M, Ruiz M, Luigetti M, Salvalaggio A, Castellani F, Testi S, Ferrarini M, Cavallaro T, Gasparotti R, Fabrizi GM, Briani C. Sporadic hereditary neuropathies misdiagnosed as chronic inflammatory demyelinating polyradiculoneuropathy: Pitfalls and red flags. J Peripher Nerv Syst 2020; 25:19-26. [DOI: 10.1111/jns.12362] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/31/2019] [Accepted: 01/03/2020] [Indexed: 12/18/2022]
Affiliation(s)
| | - Federica Taioli
- Department of Neurology, Azienda Ospedaliera Universitaria IntegrataUniversity Hospital G.B. Rossi Verona Italy
| | | | - Marta Ruiz
- Department of NeurosciencesUniversity of Padova Padova Italy
| | - Marco Luigetti
- Neurology Unit, Fondazione Policlinico Universitario Gemelli IRCCS Rome Italy
| | | | | | - Silvia Testi
- Department of Neurology, Azienda Ospedaliera Universitaria IntegrataUniversity Hospital G.B. Rossi Verona Italy
| | - Moreno Ferrarini
- Department of Neurology, Azienda Ospedaliera Universitaria IntegrataUniversity Hospital G.B. Rossi Verona Italy
| | - Tiziana Cavallaro
- Department of Neurology, Azienda Ospedaliera Universitaria IntegrataUniversity Hospital G.B. Rossi Verona Italy
| | - Roberto Gasparotti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of Brescia Brescia Italy
| | - Gian Maria Fabrizi
- Department of Neurology, Azienda Ospedaliera Universitaria IntegrataUniversity Hospital G.B. Rossi Verona Italy
| | - Chiara Briani
- Department of NeurosciencesUniversity of Padova Padova Italy
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18
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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: 123] [Impact Index Per Article: 30.8] [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.
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19
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Sural nerve biopsy in peripheral neuropathies: 30-year experience from a single center. Neurol Sci 2019; 41:341-346. [DOI: 10.1007/s10072-019-04082-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 09/18/2019] [Indexed: 12/15/2022]
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Hereditary transthyretin amyloidosis: a model of medical progress for a fatal disease. Nat Rev Neurol 2019; 15:387-404. [PMID: 31209302 DOI: 10.1038/s41582-019-0210-4] [Citation(s) in RCA: 227] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2019] [Indexed: 02/06/2023]
Abstract
Hereditary amyloidogenic transthyretin (ATTRv) amyloidosis with polyneuropathy (also known as familial amyloid polyneuropathy) is a condition with adult onset caused by mutation of transthyretin (TTR) and characterized by extracellular deposition of amyloid and destruction of the somatic and autonomic PNS, leading to loss of autonomy and death. This disease represents a model of the scientific and medical progress of the past 30 years. ATTRv amyloidosis is a worldwide disease with broad genetic and phenotypic heterogeneity that presents a diagnostic challenge for neurologists. The pathophysiology of the neuropathy is increasingly understood and includes instability and proteolysis of mutant TTR leading to deposition of amyloid with variable lengths of fibrils, microangiopathy and involvement of Schwann cells. Wild-type TTR is amyloidogenic in older individuals. The main symptoms are neuropathic, but the disease is systemic; neurologists should be aware of cardiac, eye and kidney involvement that justify a multidisciplinary approach to management. Infiltrative cardiomyopathy is usually latent but present in half of patients. Disease-modifying therapeutics that have been developed include liver transplantation and TTR stabilizers, both of which can slow progression of the disease and increase survival in the early stages. Most recently, gene-silencing drugs have been used to control disease in the more advanced stages and produce some degree of improvement.
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21
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Ricci L, Luigetti M, Florio L, Capone F, Di Lazzaro V. Causes of chronic neuropathies: a single-center experience. Neurol Sci 2019; 40:1611-1617. [PMID: 31001716 DOI: 10.1007/s10072-019-03899-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 04/12/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Chronic neuropathies are a common cause of neurological disability worldwide. However, few reports have evaluated, in real life, the prevalence of the several conditions which can cause it. PATIENTS AND METHODS The authors reviewed informatic database for outpatient office to confirm identification of chronic neuropathy in a 3-year interval period. RESULTS Among the 100 selected patients with chronic neuropathies, almost one fifth (19%) remained idiopathic. The most common etiologies were diabetes (17%), dysimmune neuropathies (38%), and vitamin B12 deficiency (9%). In the "dysimmune neuropathies" group, we distinguished various etiologies, including dysimmune neuropathies associated or not with systemic autoimmune diseases (7 and 3%, respectively), chronic inflammatory polyneuropathy (CIDP) (8%), multifocal motor neuropathy (MMN) (3%), paraproteinemic (8%), celiac disease-related (6%), and paraneoplastic (3%) neuropathies. CONCLUSIONS In this report from a single neurological center, treatable causes of chronic neuropathies, such as dysimmune neuropathies, including CIDP, and celiac disease-associated neuropathy, were common. These findings suggest the utility of routine screening with blood testing for dysimmune neuropathy and celiac disease for all patients presenting with idiopathic chronic polyneuropathy in whom primary diagnostic testings had failed to identify an etiology for the disease. SIGNIFICANCE Our results indicate that patients with peripheral neuropathy could receive a benefit from being evaluated routinely in a specialized neurological center, as many of the conditions that were discovered represented potentially treatable causes of neuropathy.
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Affiliation(s)
- Lorenzo Ricci
- Unit of Neurology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy.
| | - Marco Luigetti
- IRCCS, UOC Neurologia, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Università Cattolica del Sacro Cuore, Sede di Roma, Rome, Italy
| | - Lucia Florio
- Unit of Neurology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Fioravante Capone
- Unit of Neurology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
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22
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Conceição I, Damy T, Romero M, Galán L, Attarian S, Luigetti M, Sadeh M, Sarafov S, Tournev I, Ueda M. Early diagnosis of ATTR amyloidosis through targeted follow-up of identified carriers of TTR gene mutations. Amyloid 2019; 26:3-9. [PMID: 30793974 DOI: 10.1080/13506129.2018.1556156] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Diagnosis in the early stages of hereditary transthyretin (ATTR) amyloidosis is imperative to support timely treatment to prevent or delay disease progression. Genetic testing in the setting of genetic counselling enables identification of carriers of a TTR gene mutation who are therefore at risk of developing TTR-associated disease. Knowledge of different genotypes and how they manifest in symptomatic disease should facilitate development of a structured and targeted approach to enable diagnosis of symptomatic disease in ATTR amyloidosis mutation carriers on the first manifestation of the earliest detectable sign or symptom. A group of experts from across Europe, Israel and Japan met to reach a consensus on such an approach. The proposed approach involves establishing a baseline for key clinical parameters, determination of the timing and frequency of follow-up in TTR mutation carriers based on a predicted age of disease onset, and recognition of the likely initial clinical signs and symptoms aligned with the phenotype of the specific TTR gene mutation and family history. Minimum criteria for diagnosis of symptomatic disease have been agreed, which it is hoped will ensure diagnosis of ATTR amyloidosis at the earliest possible stage in people with a known TTR mutation.
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Affiliation(s)
- Isabel Conceição
- a CHLN-Hospital Santa Maria, IMM, Universidade de Lisboa , Lisbon , Portugal
| | - Thibaud Damy
- b Referral Center for Cardiac Amyloidosis, Department of Cardiology, Amyloid Research Institute, DHU A-TVB, Henri Mondor Hospital, APHP, IMRB and UPEC, Créteil, France
| | - Manuel Romero
- c Hospital Universitario Virgen de la Victoria , Malaga , Spain
| | - Lucía Galán
- d Hospital Clinico San Carlos , Madrid , Spain
| | | | - Marco Luigetti
- f UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,g Universita Cattolica del Sacro Cuore, Rome, Italy
| | | | - Stayko Sarafov
- i Clinic of Neurology, Alexandrovska Hospital, Department of Neurology , Medical University , Sofia , Bulgaria
| | - Ivailo Tournev
- i Clinic of Neurology, Alexandrovska Hospital, Department of Neurology , Medical University , Sofia , Bulgaria.,j Department of Cognitive Science and Psychology , New Bulgarian University , Sofia , Bulgaria
| | - Mitsuharu Ueda
- k Department of Neurology , Kumamoto University , Kumamoto , Japan
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23
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Luigetti M, Primiano G, Bisogni G, Cuccagna C, Carrozzo R, Obici L, Bernardo D, Sancricca C, Servidei S. Progressive axonal polyneuropathy in a mitochondrial disorder: an uncommon association with familial amyloid neuropathy. Amyloid 2018; 25:261-262. [PMID: 30193540 DOI: 10.1080/13506129.2018.1506919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Marco Luigetti
- a Fondazione Policlinico Universitario A. Gemelli IRCCS , UOC Neurologia, Roma , Italia.,b Università Cattolica del Sacro Cuore , Roma , Italia
| | - Guido Primiano
- c Fondazione Policlinico Universitario A. Gemelli IRCCS , UOC Neurofisiopatologia, Roma , Italia
| | | | - Cristina Cuccagna
- e Fondazione Policlinico Universitario A. Gemelli IRCCS , UOC Neurologia, Roma , Italia
| | - Rosalba Carrozzo
- f Unit of Neuromuscular and Neurodegenerative Disorders , Bambino Gesù Children's Research Hospital , Rome , Italy
| | - Laura Obici
- g Amyloidosis Research and Treatment Center , Foundation IRCCS Policlinico San Matteo, Pavia , Italy
| | | | - Cristina Sancricca
- i Fondazione Policlinico Universitario A. Gemelli IRCCS , UOC Neurologia, Roma , Italia
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24
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Luigetti M, Bisogni G, Romano A, Di Paolantonio A, Barbato F, Primicerio G, Rossini PM, Servidei S, Sabatelli M. Sudoscan in the evaluation and follow-up of patients and carriers with TTR mutations: experience from an Italian Centre. Amyloid 2018; 25:242-246. [PMID: 30638075 DOI: 10.1080/13506129.2018.1545640] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the utility of Sudoscan as possible marker of disease progression and disease onset in a cohort of hereditary ATTR amyloidosis (hATTR amyloidosis) polyneuropathy patients and carriers. PATIENTS AND METHODS We regularly performed different clinical scales, nerve conductions studies (NCS), and Sudoscan on a cohort of hATTR amyloidosis patients and carriers from a single centre of central Italy, a non-endemic area, in the last 2 years. RESULTS About 18 hATTR amyloidosis patients and 8 asymptomatic carriers were enrolled. All patients had a neuropathy affecting large fibres, small fibres or both. Two subjects developed symptoms and neurophysiological alterations during follow-up. Sudoscan data from hand and feet inversely correlated with neuropathy severity and with disease duration. Moreover, global disease status, expressed by Kumamoto scale also inversely correlated with Sudoscan values. CONCLUSIONS We confirmed that Sudoscan is a reliable marker of disease progression in late-onset hATTR amyloidosis patients and we suggest its possible utility in early detection of disease in this population.
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Affiliation(s)
- Marco Luigetti
- a UOC Neurologia , Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma , Italia.,b Università Cattolica del Sacro Cuore , Roma , Italia
| | | | - Angela Romano
- b Università Cattolica del Sacro Cuore , Roma , Italia
| | | | | | | | - Paolo Maria Rossini
- a UOC Neurologia , Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma , Italia.,b Università Cattolica del Sacro Cuore , Roma , Italia
| | - Serenella Servidei
- b Università Cattolica del Sacro Cuore , Roma , Italia.,d UOC Neurofisiopatologia , Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma , Italia
| | - Mario Sabatelli
- b Università Cattolica del Sacro Cuore , Roma , Italia.,c Centro Clinico NEMO Adulti , Roma , Italia
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25
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Ambrosini A, Calabrese D, Avato FM, Catania F, Cavaletti G, Pera MC, Toscano A, Vita G, Monaco L, Pareyson D. The Italian neuromuscular registry: a coordinated platform where patient organizations and clinicians collaborate for data collection and multiple usage. Orphanet J Rare Dis 2018; 13:176. [PMID: 30286784 PMCID: PMC6172847 DOI: 10.1186/s13023-018-0918-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/21/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The worldwide landscape of patient registries in the neuromuscular disease (NMD) field has significantly changed in the last 10 years, with the international TREAT-NMD network acting as strong driver. At the same time, the European Medicines Agency and the large federations of rare disease patient organizations (POs), such as EURORDIS, contributed to a great cultural change, by promoting a paradigm shift from product-registries to patient-centred registries. In Italy, several NMD POs and Fondazione Telethon undertook the development of a TREAT-NMD linked patient registry in 2009, with the referring clinical network providing input and support to this initiative through the years. This article describes the outcome of this joint effort and shares the experience gained. METHODS The Italian NMD registry is based on an informatics technology platform, structured according to the most rigorous legal national and European requirements for management of patient sensitive data. A user-friendly web interface allows both direct patients and clinicians' participation. The platform's design permits expansion to incorporate new modules and new registries, and is suitable of interoperability with other international efforts. RESULTS When the Italian NMD Registry was initiated, an ad hoc legal entity (NMD Registry Association) was devised to manage registries' data. Currently, several disease-specific databases are hosted on the platform. They collect molecular and clinical details of individuals affected by Duchenne or Becker muscular dystrophy, Charcot-Marie-Tooth disease, transthyretin type-familial amyloidotic polyneuropathy, muscle glycogen storage disorders, spinal and bulbar muscular atrophy, and spinal muscular atrophy. These disease-specific registries are at different stage of development, and the NMD Registry itself has gone through several implementation steps to fulfil different technical and governance needs. The new governance model is based on the agreement between the NMD Registry Association and the professional societies representing the Italian NMD clinical network. Overall, up to now the NMD registry has collected data on more than 2000 individuals living with a NMD condition. CONCLUSIONS The Italian NMD Registry is a flexible platform that manages several condition-specific databases and is suitable to upgrade. All stakeholders participate in its management, with clear roles and responsibilities. This governance model has been key to its success. In fact, it favored patient empowerment and their direct participation in research, while also engaging the expert clinicians of the Italian network in the collection of accurate clinical data according to the best clinical practices.
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Affiliation(s)
| | - Daniela Calabrese
- UOC Malattie neurodegenerative e neurometaboliche rare, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | | | - Guido Cavaletti
- School of Medicine and Surgery and Experimental Neurology Unit, University of Milano-Bicocca, Monza, Italy
| | - Maria Carmela Pera
- Paediatric Neurology and Centro Clinico Nemo, Catholic University and Policlinico Gemelli, Rome, Italy
| | - Antonio Toscano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Vita
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Lucia Monaco
- Fondazione Telethon, Via Poerio 14, 20129 Milan, Italy
| | - Davide Pareyson
- UOC Malattie neurodegenerative e neurometaboliche rare, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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26
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Patel K, Tagoe C, Bieri P, Weidenheim K, Tauras JM. A case of transthyretin amyloidosis with myopathy, neuropathy, and cardiomyopathy resulting from an exceedingly rare mutation transthyretin Ala120Ser (c.418G > T, p.Ala140Ser). Amyloid 2018; 25:211-212. [PMID: 30039724 DOI: 10.1080/13506129.2018.1491398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Kavisha Patel
- a Department of Internal Medicine , Jacobi Medical Center, Albert Einstein College of Medicine , Bronx , NY , USA
| | - Clement Tagoe
- b Department of Rheumatology , Montefiore Medical Center, Albert Einstein College of Medicine , Bronx , NY , USA
| | - Phyllis Bieri
- c Saul Korey Department of Neurology , Montefiore Medical Center, Albert Einstein College of Medicine , Bronx , NY , USA
| | - Karen Weidenheim
- c Saul Korey Department of Neurology , Montefiore Medical Center, Albert Einstein College of Medicine , Bronx , NY , USA.,d Department of Pathology , Montefiore Medical Center, Albert Einstein College of Medicine , Bronx , NY , USA.,e Davidoff Department of Neurosurgery , Montefiore Medical Center, Albert Einstein College of Medicine , Bronx , NY , USA
| | - James M Tauras
- f Department of Cardiology , Montefiore Medical Center, Albert Einstein College of Medicine , Bronx , NY , USA
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27
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Peripheral Nervous System Involvement in Lymphoproliferative Disorders. Mediterr J Hematol Infect Dis 2018; 10:e2018057. [PMID: 30210750 PMCID: PMC6131106 DOI: 10.4084/mjhid.2018.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/06/2018] [Indexed: 01/04/2023] Open
Abstract
Peripheral neuropathies are a vast group of diseases with heterogeneous aetiologies, including genetic and acquired causes. Several haematological disorders may cause an impairment of the peripheral nervous system, with diverse mechanisms and variable clinical, electrophysiological and pathological manifestations. In this practical review, we considered the main phenotypes of peripheral nervous system diseases associated with lymphoproliferative disorders. The area of intersection of neurological and haematological fields is of particular complexity and raises specific problems in the clinical practice of lymphoproliferative disorders. The personal crosstalk between neurologists and haematologists remains a fundamental tool for a proper diagnostic process which may lead to successful treatments in most cases.
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28
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Bishop E, Brown EE, Fajardo J, Barouch LA, Judge DP, Halushka MK. Seven factors predict a delayed diagnosis of cardiac amyloidosis. Amyloid 2018; 25:174-179. [PMID: 30169971 DOI: 10.1080/13506129.2018.1498782] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Diagnostic delay of cardiac amyloidosis (CAm) continues to challenge clinicians. We investigated features associated with delay and ascertained if a diagnostic delay had negative implications for the patient. METHODS We performed a retrospective chart review identifying 82 subjects with biopsy-proven and mass-spectrometry-identified CAm with clinical and epidemiologic data including first potential symptom of amyloidosis. Pathology slides were scored for extent of amyloid. Robust statistical analyses including generalized linear and ordered logistic regression analysis were performed. RESULTS There was a 22 month (median) delay in diagnosis, more pronounced (34 months) in subjects with transthyretin (ATTR) amyloidosis. Seven factors predict a delayed diagnosis including ATTR amyloid type (ratio =2.17, 95% CI 1.31-3.59), having carpal tunnel syndrome (2.13, CI 1.49-3.03) and age <70 at first symptom (1.85, CI 1.30-2.61). Individuals with delays of 1+ years had higher levels of NT proBNP (4451 vs. 2559 pg/mL, p = .016) and longer PR intervals (225 vs. 162 ms, p < .001) at the time of diagnosis. CONCLUSIONS Diagnostic delays negatively affect cardiac function. Of the predictive clinical features, carpal tunnel syndrome was frequent and its presence should lead to a more aggressive analysis for CAm in the appropriate clinical settings.
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Affiliation(s)
- Eve Bishop
- a Division of Cardiovascular Pathology, Department of Pathology , Johns Hopkins University , Baltimore , MD , USA
| | - Emily E Brown
- b Center for Inherited Heart Disease, Johns Hopkins University , Baltimore , MD , USA
| | - Johana Fajardo
- c Division of Cardiology, Department of Medicine , Medical University of South Carolina , Charleston , SC , USA
| | - Lili A Barouch
- d Division of Cardiology, Department of Medicine , Johns Hopkins University , Baltimore , MD , USA
| | - Daniel P Judge
- c Division of Cardiology, Department of Medicine , Medical University of South Carolina , Charleston , SC , USA.,d Division of Cardiology, Department of Medicine , Johns Hopkins University , Baltimore , MD , USA
| | - Marc K Halushka
- a Division of Cardiovascular Pathology, Department of Pathology , Johns Hopkins University , Baltimore , MD , USA
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29
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Iorio A, De Lillo A, De Angelis F, Di Girolamo M, Luigetti M, Sabatelli M, Pradotto L, Mauro A, Mazzeo A, Stancanelli C, Perfetto F, Frusconi S, My F, Manfellotto D, Fuciarelli M, Polimanti R. Non-coding variants contribute to the clinical heterogeneity of TTR amyloidosis. Eur J Hum Genet 2017. [PMID: 28635949 DOI: 10.1038/ejhg.2017.95] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Coding mutations in TTR gene cause a rare hereditary form of systemic amyloidosis, which has a complex genotype-phenotype correlation. We investigated the role of non-coding variants in regulating TTR gene expression and consequently amyloidosis symptoms. We evaluated the genotype-phenotype correlation considering the clinical information of 129 Italian patients with TTR amyloidosis. Then, we conducted a re-sequencing of TTR gene to investigate how non-coding variants affect TTR expression and, consequently, phenotypic presentation in carriers of amyloidogenic mutations. Polygenic scores for genetically determined TTR expression were constructed using data from our re-sequencing analysis and the GTEx (Genotype-Tissue Expression) project. We confirmed a strong phenotypic heterogeneity across coding mutations causing TTR amyloidosis. Considering the effects of non-coding variants on TTR expression, we identified three patient clusters with specific expression patterns associated with certain phenotypic presentations, including late onset, autonomic neurological involvement, and gastrointestinal symptoms. This study provides novel data regarding the role of non-coding variation and the gene expression profiles in patients affected by TTR amyloidosis, also putting forth an approach that could be used to investigate the mechanisms at the basis of the genotype-phenotype correlation of the disease.
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Affiliation(s)
- Andrea Iorio
- Department of Biology, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Marco Di Girolamo
- Clinical Pathophysiology Center, AFaR Foundation - 'San Giovanni Calibita' Fatebenefratelli Hospital, Rome, Italy
| | - Marco Luigetti
- Department of Geriatrics, Institute of Neurology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.,Department of Neurosciences, Institute of Neurology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.,Department of Orthopedics, Institute of Neurology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | | | - Luca Pradotto
- Division of Neurology and Neurorehabilitation, San Giuseppe Hospital, IRCCS-Istituto Auxologico Italiano, Piancavallo (VB), Italy
| | - Alessandro Mauro
- Division of Neurology and Neurorehabilitation, San Giuseppe Hospital, IRCCS-Istituto Auxologico Italiano, Piancavallo (VB), Italy.,Department of Neuroscience, University of Turin, Turin, Italy
| | - Anna Mazzeo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Claudia Stancanelli
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Federico Perfetto
- Regional Amyloid Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Sabrina Frusconi
- Genetic Diagnostics Unit, Laboratory Department, Careggi University Hospital, Florence, Italy
| | - Filomena My
- Division of Neurology, 'Vito Fazzi Hospital', Lecce, Italy
| | - Dario Manfellotto
- Clinical Pathophysiology Center, AFaR Foundation - 'San Giovanni Calibita' Fatebenefratelli Hospital, Rome, Italy
| | - Maria Fuciarelli
- Department of Biology, University of Rome Tor Vergata, Rome, Italy
| | - Renato Polimanti
- Department of Psychiatry, Yale University School of Medicine, West Haven, CT, USA.,VA CT Healthcare Center, West Haven, CT, USA
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30
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Shibata Y, Matsushima M, Yabe I, Matsuda K, Nagai A, Kano T, Yamada T, Sekijima Y, Sasaki H. Pseudo-homozygous mutation due to a primer site polymorphism in hereditary ATTR amyloidosis: a pitfall of PCR-based genetic testing. Amyloid 2017; 24:66-67. [PMID: 28393577 DOI: 10.1080/13506129.2017.1307821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Yuka Shibata
- a Division of Clinical Genetics , Hokkaido University Hospital , Sapporo , Japan
| | - Masaaki Matsushima
- a Division of Clinical Genetics , Hokkaido University Hospital , Sapporo , Japan.,b Department of Neurology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Ichiro Yabe
- a Division of Clinical Genetics , Hokkaido University Hospital , Sapporo , Japan.,b Department of Neurology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Koichiro Matsuda
- c Molecular Genetic Testing Group, Molecular Genetic Analysis Department , Molecular Pathology Esoteric Analysis Center, LSI Medience Corporation , Tokyo , Japan
| | - Azusa Nagai
- b Department of Neurology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Takahiro Kano
- b Department of Neurology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Takahiro Yamada
- a Division of Clinical Genetics , Hokkaido University Hospital , Sapporo , Japan
| | - Yoshiki Sekijima
- d Department of Medicine (Neurology and Rheumatology) , Shinshu University School of Medicine , Matsumoto , Japan
| | - Hidenao Sasaki
- a Division of Clinical Genetics , Hokkaido University Hospital , Sapporo , Japan.,b Department of Neurology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
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31
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Pearson KT, Vota S. Amyloidosis and its management: Amyloid neuropathies. Curr Probl Cancer 2016; 40:198-208. [PMID: 27979324 DOI: 10.1016/j.currproblcancer.2016.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 08/25/2016] [Accepted: 08/26/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Kathleen Thornton Pearson
- Department of Neurology, Virginia Commonwealth University, 417 N. 11th Street Richmond, Virginia 23298.
| | - Scott Vota
- Department of Neurology, Virginia Commonwealth University, 417 N. 11th Street Richmond, Virginia 23298.
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32
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Meng LC, Lyu H, Zhang W, Liu J, Wang ZX, Yuan Y. Hereditary Transthyretin Amyloidosis in Eight Chinese Families. Chin Med J (Engl) 2016; 128:2902-5. [PMID: 26521788 PMCID: PMC4756886 DOI: 10.4103/0366-6999.168048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Mutations of transthyretin (TTR) cause the most common type of autosomal-dominant hereditary systemic amyloidosis, which occurs worldwide. To date, more and more mutations in the TTR gene have been reported. Some variations in the clinical presentation are often observed in patients with the same mutation or the patients in the same family. The purpose of this study was to find out the clinicopathologic and genetic features of Chinese patients with hereditary TTR amyloidosis. Methods: Clinical and necessary examination materials were collected from nine patients of eight families with hereditary TTR amyloidosis at Peking University First Hospital from January 2007 to November 2014. Sural nerve biopsies were taken for eight patients and skin biopsies were taken in the calf/upper arm for two patients, for light and electron microscopy examination. The TTR genes from the nine patients were analyzed. Results: The onset age varied from 23 to 68 years. The main manifestations were paresthesia, proximal and/or distal weakness, autonomic dysfunction, cardiomyopathy, vitreous opacity, hearing loss, and glossohypertrophia. Nerve biopsy demonstrated severe loss of myelinated fibers in seven cases and amyloid deposits in three. One patient had skin amyloid deposits which were revealed from electron microscopic examination. Genetic analysis showed six kinds of mutations of TTR gene, including Val30Met, Phe33Leu, Ala36Pro, Val30Ala, Phe33Val, and Glu42Gly in exon 2. Conclusions: Since the pathological examinations of sural nerve were negative for amyloid deposition in most patients, the screening for TTR mutations should be performed in all the adult patients, who are clinically suspected with hereditary TTR amyloidosis.
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Affiliation(s)
| | | | | | | | | | - Yun Yuan
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
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33
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Chen H, Zhou X, Wang J, Wang X, Liu L, Wu S, Li T, Chen S, Yang J, Sham PC, Zhu G, Zhang X, Wang B. Exome Sequencing and Gene Prioritization Correct Misdiagnosis in a Chinese Kindred with Familial Amyloid Polyneuropathy. Sci Rep 2016; 6:26362. [PMID: 27212199 PMCID: PMC4876459 DOI: 10.1038/srep26362] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/26/2016] [Indexed: 11/09/2022] Open
Abstract
Inherited neuropathies show considerable heterogeneity in clinical manifestations and genetic etiologies, and are therefore often difficult to diagnose. Whole-exome sequencing (WES) has been widely adopted to make definite diagnosis of unclear conditions, with proven efficacy in optimizing patients' management. In this study, a large Chinese kindred segregating autosomal dominant polyneuropathy with incomplete penetrance was ascertained through a patient who was initially diagnosed as Charcot-Marie-Tooth disease. To investigate the genetic cause, forty-six living family members were genotyped by SNP microarrays, and one confirmed patient was subject to WES. Through systematic computational prioritization, we identified a missense mutation c.G148T in TTR gene which results in a p.V50L substitution known to cause transthyretin-related familial amyloid polyneuropathy. Co-segregation analysis and clinical follow-up confirmed the new diagnosis, which suggested new therapeutic options to the patients and informed high risk family members. This study confirms WES as a powerful tool in translational medicine, and further demostrates the practical utility of gene prioritization in narrowing the scope of causative mutation.
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Affiliation(s)
- Hui Chen
- Department of Neurology, Military General Hospital of Beijing PLA, Beijing, China
| | - Xueya Zhou
- MOE Key Laboratory of Bioinformatics, Bioinformatics Division and Center for Synthetic and Systems Biology, TNLIST/Department of Automation, Tsinghua University, Beijing, China.,Department of Psychiatry and Centre for Genomic Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Jing Wang
- Department of Medical Genetics, The Capital Medical University, Beijing, China
| | - Xi Wang
- National Research Institute of Family Planning, Beijing, China
| | - Liyang Liu
- MOE Key Laboratory of Bioinformatics, Bioinformatics Division and Center for Synthetic and Systems Biology, TNLIST/Department of Automation, Tsinghua University, Beijing, China
| | - Shinan Wu
- National Research Institute of Family Planning, Beijing, China
| | - Tengyan Li
- National Research Institute of Family Planning, Beijing, China
| | - Si Chen
- National Research Institute of Family Planning, Beijing, China
| | - Jingwen Yang
- National Research Institute of Family Planning, Beijing, China
| | - Pak Chung Sham
- Department of Psychiatry and Centre for Genomic Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Guangming Zhu
- Department of Neurology, Military General Hospital of Beijing PLA, Beijing, China
| | - Xuegong Zhang
- MOE Key Laboratory of Bioinformatics, Bioinformatics Division and Center for Synthetic and Systems Biology, TNLIST/Department of Automation, Tsinghua University, Beijing, China
| | - Binbin Wang
- National Research Institute of Family Planning, Beijing, China
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Monitoring effectiveness and safety of Tafamidis in transthyretin amyloidosis in Italy: a longitudinal multicenter study in a non-endemic area. J Neurol 2016; 263:916-924. [DOI: 10.1007/s00415-016-8064-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 10/22/2022]
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Adams D, Cauquil C, Labeyrie C, Beaudonnet G, Algalarrondo V, Théaudin M. TTR kinetic stabilizers and TTR gene silencing: a new era in therapy for familial amyloidotic polyneuropathies. Expert Opin Pharmacother 2016; 17:791-802. [PMID: 26800456 DOI: 10.1517/14656566.2016.1145664] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Transthyretin Familial Amyloid Polyneuropathy (TTR-FAP) is a rare disease with autosomal dominant transmission due to a point mutation of the TTR gene. By removing the main source of systemic mutant TTR, liver transplantation (LT) has become the reference therapy of this severe and fatal polyneuropathy of adult-onset, stopping disease progression in subgroup of patients. Recently, new therapeutic strategies have emerged, which intend to stabilize TTR or to silence the TTR gene. Amongst them, the TTR kinetic stabilizer tafamidis is the first drug approved in the EU. AREAS COVERED We shall review the natural history of TTR-FAP and the best indications for LT. Data on the efficacy, safety and tolerability of the TTR kinetic stabilizers, tafamidis and diflunisal, have been reviewed, from the pivotal Phase III clinical trials published in PubMed medical journals or presented at international meetings. We will review the ongoing phase III clinical trials of TTR gene silencing with RNAi therapeutics and ASO published in clinicaltrialgov. EXPERT OPINION Due to the data on efficacy, tolerability, safety, tafamidis and diflunisal became the first line anti-amyloid treatment in stage 1 TTR-FAP. Both drugs slow progression of the disease. Only tafamidis got marketing authorization. We are waiting for results of the 2 phase III clinical trials of TTR gene silencing in varied stages of the disease.
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Affiliation(s)
- David Adams
- a Neurology , CHU Bicêtre, APHP , Le Kremlin Bicêtre , France.,b National reference Center for FAP (NNERF) , Le Kremlin Bicêtre , France.,c FILNEMUS Filière nationale des maladies neuromusculaires , Marseille , France
| | - Cecile Cauquil
- a Neurology , CHU Bicêtre, APHP , Le Kremlin Bicêtre , France.,b National reference Center for FAP (NNERF) , Le Kremlin Bicêtre , France.,c FILNEMUS Filière nationale des maladies neuromusculaires , Marseille , France
| | - Céline Labeyrie
- a Neurology , CHU Bicêtre, APHP , Le Kremlin Bicêtre , France.,b National reference Center for FAP (NNERF) , Le Kremlin Bicêtre , France.,c FILNEMUS Filière nationale des maladies neuromusculaires , Marseille , France
| | - Guillemette Beaudonnet
- b National reference Center for FAP (NNERF) , Le Kremlin Bicêtre , France.,c FILNEMUS Filière nationale des maladies neuromusculaires , Marseille , France.,d Neurophysiology , CHU Bicêtre, APHP , Le Kremlin Bicêtre , France
| | - Vincent Algalarrondo
- b National reference Center for FAP (NNERF) , Le Kremlin Bicêtre , France.,c FILNEMUS Filière nationale des maladies neuromusculaires , Marseille , France.,e Cardiology , CHU A Beclere, APHP , Clamart , France
| | - Marie Théaudin
- a Neurology , CHU Bicêtre, APHP , Le Kremlin Bicêtre , France.,b National reference Center for FAP (NNERF) , Le Kremlin Bicêtre , France.,c FILNEMUS Filière nationale des maladies neuromusculaires , Marseille , France
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Mazzeo A, Russo M, Di Bella G, Minutoli F, Stancanelli C, Gentile L, Baldari S, Carerj S, Toscano A, Vita G. Transthyretin-Related Familial Amyloid Polyneuropathy (TTR-FAP): A Single-Center Experience in Sicily, an Italian Endemic Area. J Neuromuscul Dis 2015; 2:S39-S48. [PMID: 27858761 PMCID: PMC5271421 DOI: 10.3233/jnd-150091] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Familial amyloid polyneuropathy related to transthyretin gene (TTR-FAP) is a life-threatening disease transmitted as an autosomal dominant trait. Val30Met mutation accounts for the majority of the patients with large endemic foci especially in Portugal, Sweden and Japan. However, more than one hundred other mutations have been described worldwide. A great phenotypic variability among patients with late- and early-onset has been reported. Objective: To present a detailed report of TTR-FAP patients diagnosed in our tertiary neuromuscular center, in a 20-year period. Methods: Clinical informations were gathered through the database of our center. Results: The study involved 76 individuals carrying a TTR-FAP mutation. Three phenotypes were identified, each corresponding to a different TTR variant, homogeneous within and heterogeneous between each other: i) Glu89Gln mutation, characterised by 5th – 6th decade onset, neuropathy as presenting symptoms, early heart dysfunction, cardiomyopathy as major cause of mortality followed by dysautonomia and cachexia; ii) Phe64Leu mutation, marked by familiarity reported in one-half of cases, late onset, severe peripheral neuropathy, moderate dysautonomia and mild cardiomyopathy, death for wasting syndrome; iii) Thr49Ala mutation, distinguished by onset in the 5th decade, autonomic disturbances as inaugural symptoms which may remain isolated for many years, moderate polyneuropathy, cachexia as major cause of mortality followed by cardiomyopathy. Conclusions: This survey highlighted a prevalence of 8.8/1,000,000 in Sicily Island. Good knowledge of the natural history of the disease according to different TTR mutations allow clinicians to optimise multiprofessional care for patients and to offer carriers a personalized follow-up to reveal first signs of the disease.
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Affiliation(s)
- Anna Mazzeo
- Department of Neurosciences, University of Messina, Messina, Italy
| | - Massimo Russo
- NEMO SUD Center for Neuromuscular Disorders, Messina, Italy
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Fabio Minutoli
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Claudia Stancanelli
- Department of Neurosciences, University of Messina, Messina, Italy.,Biomedical Department of Internal and Specialistic Medicine, University of Palermo, Palermo, Italy
| | - Luca Gentile
- Department of Neurosciences, University of Messina, Messina, Italy
| | - Sergio Baldari
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Toscano
- Department of Neurosciences, University of Messina, Messina, Italy
| | - Giuseppe Vita
- Department of Neurosciences, University of Messina, Messina, Italy.,NEMO SUD Center for Neuromuscular Disorders, Messina, Italy
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Iorio A, De Angelis F, Di Girolamo M, Luigetti M, Pradotto L, Mauro A, Manfellotto D, Fuciarelli M, Polimanti R. Most recent common ancestor of TTR Val30Met mutation in Italian population and its potential role in genotype-phenotype correlation. Amyloid 2015; 22:73-8. [PMID: 25510352 DOI: 10.3109/13506129.2014.994597] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Transthyretin (TTR)-related amyloidosis is characterized by autosomal transmission of amyloidogenic mutated TTR. Val30Met is one of the most common amyloidogenic TTR mutations, showing a worldwide distribution with phenotypic heterogeneity among human populations. Multiple founder mutations for Val30Met foci have been hypothesized and the different origins may explain the phenotypic variability. The aim of our study is to determine the origin of Italian Val30Met and to analyze the genetic relationship of other Val30Met foci. METHODS We analyzed the origin of Italian Val30Met through 11 microsatellite markers around the TTR gene in 29 patients and 34 healthy controls. RESULTS Our genetic analysis showed an estimated age of origin of 34-36 generations ago for the Italian Val30Met. Comparing Italian Val30Met haplotypes with those from Sweden and Portugal highlights relevant differences that seem to be consistent with an independent origin of Italian Val30Met mutation. This genetic evidence agrees with the disease phenotypic variation in these populations. DISCUSSION AND CONCLUSIONS Italian Val30Met mutation should have originated before the Portuguese and Swedish Val30Met ones (which arose through independent mutational events). This indicates a genetic diversity in the surrounding regions of three different Val30Met mutations, supporting the hypothesis that TTR non-coding regions may contribute to phenotypic heterogeneity.
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Affiliation(s)
- Andrea Iorio
- Department of Biology, University of Rome "Tor Vergata" , Rome , Italy
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Adams D, Théaudin M, Cauquil C, Algalarrondo V, Slama M. FAP neuropathy and emerging treatments. Curr Neurol Neurosci Rep 2014; 14:435. [PMID: 24482069 DOI: 10.1007/s11910-013-0435-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Transthyretin familial amyloid polyneuropathy (TTR-FAP) classically presents as a length dependent small fiber polyneuropathy in endemic countries like Portugal. In nonendemic countries, it may mimic a variety of chronic polyneuropathies, with several phenotypes: ataxic, upper limb onset neuropathy, or motor. In these cases, there is usually a late onset and no positive family history. TTR gene sequencing appears the most pertinent first-line test for diagnosis. Cardiac involvement of various severities is common in FAP. Liver transplantation remains the standard antiamyloid therapy with better results in Val30Met TTR-FAP of early onset. Antiamyloid medication has been developed. (1) TTR stabilizers: Tafamidis was the first drug approved in Europe in stage 1 (walking unaided) TTR-FAP to slow progression of the disease; diflunisal has been assessed in a phase 3 clinical trial; (2) TTR gene silencing is a new strategy to inhibit production of both mutant and nonmutant TTR with antisense oligonucleotides or SiRNA (2 ongoing phase 3 clinical trials).
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Affiliation(s)
- David Adams
- APHP, HUPS, Univ Paris Sud, le Kremlin Bicêtre Cedex, France,
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Granata G, Luigetti M, Coraci D, Del Grande A, Romano A, Bisogni G, Bramanti P, Rossini PM, Sabatelli M, Padua L. Ultrasound evaluation in transthyretin-related amyloid neuropathy. Muscle Nerve 2014; 50:372-6. [PMID: 24395461 DOI: 10.1002/mus.24168] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 12/30/2013] [Accepted: 01/05/2014] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Familial amyloid polyneuropathy is a rare condition caused by mutations of the transthyretin gene (TTR). We assessed the pattern of nerve ultrasound (US) abnormalities in patients with TTR-related neuropathy. METHODS Seven patients with TTR-related neuropathy (TTR-N) and 5 asymptomatic TTR-mutation carriers (TTR-C) underwent neurological examination, nerve conduction studies, and US evaluation. RESULTS Multifocal US abnormalities were identified in 6 of 7 TTR-N patients. A single patient with only a mild sensory polyneuropathy had normal nerves on US evaluation. In the TTR-C, we only detected an enlarged ulnar nerve at the elbow. Interestingly, disease severity correlated with number of nerves affected on US evaluation. CONCLUSIONS No specific pattern of US abnormalities was identified in this cohort. However, in TTR-related amyloid neuropathy, US may be a helpful tool in monitoring disease progression, and/or clinical response to pharmacological treatment.
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Affiliation(s)
- Giuseppe Granata
- Institute of Neurology, Catholic University of Sacred Heart, Largo F. Vito 1, 00168, Rome, Italy
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Lozeron P, Théaudin M, Mincheva Z, Ducot B, Lacroix C, Adams D. Effect on disability and safety of Tafamidis in late onset of Met30 transthyretin familial amyloid polyneuropathy. Eur J Neurol 2013; 20:1539-45. [PMID: 23834402 DOI: 10.1111/ene.12225] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 06/05/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to assess the effect of Tafamidis, which slows the progression of early stages of Met30 transthyretin (TTR) familial amyloidosis polyneuropathy (FAP) in more advanced cases. METHODS The study was a prospective, non-randomized controlled trial carried out at the French national reference centre for FAP with follow-up at 1 year. Thirty-seven consecutive Met30-TTR-FAP patients were enrolled between December 2009 and July 2011, with NIS-LL (Neuropathy Impairment Score-lower limbs) > 10 and Karnofsky score > 60. Their mean (SD) age was 56.4 (19) years. Seventy-seven per cent of patients had a walking disability. Seven patients (19%) were withdrawn for adverse effects. The primary study outcome measurements, planned before data collection began, were NIS-LL and NIS-UL (upper limbs) scores and disability scores. RESULTS Of the 37 patients entered into the study, 29 were evaluated at 6 months and 13 at 12 months. During the first 6 months of treatment, the mean progression of NIS-LL score was 4.8 and was similar to that during the period before treatment. Among the 45% of patients without NIS-LL progression, the NIS-UL score worsened in 55%. During the first year, 55% deteriorated with respect to disability and 38% with respect to NIS only; only two patients (7%) remained stable. Four (out of 20; 20%) patients who were previously stage 1 reached stage 2 (walking with aid) after this period. Two out of nine patients who were initially normotensive developed orthostatic hypotension. There were a total of 19 adverse events, including four febrile urinary tract infections and three severe diarrhoeas, with faecal incontinence in two. CONCLUSION In most patients with advanced Met30 TTR-FAP, Tafamidis is not able to stop disease progression, in respect of both NIS-LL and disability. Other anti-amyloid medicines should be assessed in this context.
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Affiliation(s)
- P Lozeron
- Department of Neurology, APHP, CHU de Bicêtre, Le Kremlin Bicêtre, France; APHP, CHU de Bicêtre, French national reference centre for FAP (NNERF), Le Kremlin Bicêtre, France
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Russo M, Mazzeo A, Stancanelli C, Di Leo R, Gentile L, Di Bella G, Minutoli F, Baldari S, Vita G. Transthyretin-related familial amyloidotic polyneuropathy: description of a cohort of patients with Leu64 mutation and late onset. J Peripher Nerv Syst 2012; 17:385-90. [DOI: 10.1111/j.1529-8027.2012.00436.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | | | | | | | | | - Fabio Minutoli
- Department of Radiological Sciences, Nuclear Medicine Unit; University of Messina; Messina; Italy
| | - Sergio Baldari
- Department of Radiological Sciences, Nuclear Medicine Unit; University of Messina; Messina; Italy
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