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Živković SA, Lacomis D, Soman P. Neuromuscular manifestations of wild type transthyretin amyloidosis: a review and single center's experience. Front Cardiovasc Med 2024; 11:1345608. [PMID: 38410247 PMCID: PMC10894993 DOI: 10.3389/fcvm.2024.1345608] [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: 11/28/2023] [Accepted: 02/02/2024] [Indexed: 02/28/2024] Open
Abstract
Transthyretin amyloidosis (ATTR) is a condition defined by accumulation of insoluble transthyretin amyloid deposits in multiple organs, especially in the peripheral nerve and heart muscle. ATTR may result from transthyretin mutations (variant ATTR or ATTRv) or may occur with normal transthyretin genotype (wild type ATTR or ATTRwt). ATTRwt was previously known as "senile amyloidosis" and causes cardiomyopathy which may lead to heart failure with a preserved ejection fraction, affecting predominantly elderly men. The exact prevalence of ATTRwt in the general population remains unclear, but its occurrence may be underestimated in women. It was observed that a proportion of ATTRwt cardiomyopathy patients may develop slowly progressing neuropathy that is milder and indolent in comparison with typical progressive neuropathy associated with ATTRv. Furthermore, the causality of neuropathy is often uncertain in patients with ATTRwt. Neuropathy symptoms, including distal sensory loss, unsteadiness and (neuropathic) pain are common in elderly patients with multiple potential causes, and as ATTRwt patients are typically older, relatively high prevalence of peripheral neuropathy is expected with frequent comorbidities. Relatively high prevalence of ATTRwt in elderly population contrasts few documented cases of neuropathy caused by ATTRwt, and there is uncertainty whether ATTRwt neuropathy is an infrequent occurrence or a significant manifestation of multisystemic ATTRwt. We review neurologic and musculoskeletal manifestations of ATTRwt and present clinical features of a single center cohort of ATTRwt patients with suspected peripheral neuropathy.
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Affiliation(s)
- Sasha A Živković
- Department of Neurology, Yale University, New Haven, CT, United States
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
- Cardiac Amyloidosis Center, UPMC Heart and Vascular Institute, Pittsburgh, PA, United States
| | - David Lacomis
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
- Department of Pathology (Neuropathology), University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Prem Soman
- Cardiac Amyloidosis Center, UPMC Heart and Vascular Institute, Pittsburgh, PA, United States
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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2
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Plantone D, Primiano G, Righi D, Romano A, Luigetti M, De Stefano N. Current Evidence Supporting the Role of Immune Response in ATTRv Amyloidosis. Cells 2023; 12:2383. [PMID: 37830598 PMCID: PMC10572348 DOI: 10.3390/cells12192383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 10/14/2023] Open
Abstract
Hereditary transthyretin (ATTRv) amyloidosis with polyneuropathy, also known as familial amyloid polyneuropathy (FAP), represents a progressive, heterogeneous, severe, and multisystemic disease caused by pathogenic variants in the TTR gene. This autosomal-dominant neurogenetic disorder has an adult onset with variable penetrance and an inconstant phenotype, even among subjects carrying the same mutation. Historically, ATTRv amyloidosis has been viewed as a non-inflammatory disease, mainly due to the absence of any mononuclear cell infiltration in ex vivo tissues; nevertheless, a role of inflammation in its pathogenesis has been recently highlighted. The immune response may be involved in the development and progression of the disease. Fibrillary TTR species bind to the receptor for advanced glycation end products (RAGE), probably activating the nuclear factor κB (NF-κB) pathway. Moreover, peripheral blood levels of several cytokines, including interferon (IFN)-gamma, IFN-alpha, IL-6, IL-7, and IL-33, are altered in the course of the disease. This review summarizes the current evidence supporting the role of the immune response in ATTRv amyloidosis, from the pathological mechanisms to the possible therapeutic implications.
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Affiliation(s)
- Domenico Plantone
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (D.R.); (N.D.S.)
| | - Guido Primiano
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (A.R.); (M.L.)
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Delia Righi
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (D.R.); (N.D.S.)
| | - Angela Romano
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (A.R.); (M.L.)
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marco Luigetti
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.P.); (A.R.); (M.L.)
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (D.R.); (N.D.S.)
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Thimm A, Carpinteiro A, Oubari S, Papathanasiou M, Kessler L, Rischpler C, Malik RA, Herrmann K, Reinhardt HC, Rassaf T, Kleinschnitz C, Hagenacker T, Stettner M. Corneal confocal microscopy identifies corneal nerve loss and increased Langerhans cells in presymptomatic carriers and patients with hereditary transthyretin amyloidosis. J Neurol 2023:10.1007/s00415-023-11689-z. [PMID: 37014422 DOI: 10.1007/s00415-023-11689-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/21/2023] [Accepted: 03/25/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Hereditary transthyretin amyloidosis (ATTRv amyloidosis) is a rare, but life-threatening protein misfolding disorder due to TTR gene mutations. Cardiomyopathy (ATTRv-CM) and polyneuropathy (ATTRv-PN) with early small nerve fibre involvement are the most common manifestations. Timely diagnosis and treatment initiation are key to limiting progression of disease. Corneal confocal microscopy (CCM) is a non-invasive method to quantify corneal small nerve fibres and immune cell infiltrates in vivo. METHODS This cross-sectional study investigated the utility of CCM in 20 patients with ATTRv amyloidosis (ATTRv-CM, n = 6; ATTRv-PN, n = 14) and presymptomatic carriers (n = 5) compared to 20 age- and sex-matched healthy controls. Corneal nerve fibre density, corneal nerve fibre length, corneal nerve branch density, and cell infiltrates were assessed. RESULTS Corneal nerve fibre density and nerve fibre length were significantly lower in patients with ATTRv amyloidosis compared to healthy controls regardless of the clinical phenotype (ATTRv-CM, ATTRv-PN) and corneal nerve fibre density was significantly lower in presymptomatic carriers. Immune cell infiltrates were only evident in patients with ATTRv amyloidosis, which correlated with reduced corneal nerve fibre density. CONCLUSIONS CCM identifies small nerve fibre damage in presymptomatic carriers and symptomatic patients with ATTRv amyloidosis and may serve as a predictive surrogate marker to identify individuals at risk of developing symptomatic amyloidosis. Furthermore, increased corneal cell infiltration suggests an immune-mediated mechanism in the pathogenesis of amyloid neuropathy.
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Affiliation(s)
- Andreas Thimm
- Department of Neurology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
- Center for Translational Neuro- and Behavioral Scienes (C-TNBS), University Hospital Essen, Essen, Germany.
| | - Alexander Carpinteiro
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, Essen, Germany
- Institute of Molecular Biology, University of Duisburg-Essen, Essen, Germany
| | - Sara Oubari
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Maria Papathanasiou
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Lukas Kessler
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | | | - Rayaz Ahmed Malik
- Institute of Cardiovascular Science, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
- Weill Cornell Medicine-Qatar, Education City, Doha, Qatar
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Hans Christian Reinhardt
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Center for Translational Neuro- and Behavioral Scienes (C-TNBS), University Hospital Essen, Essen, Germany
| | - Tim Hagenacker
- Department of Neurology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Center for Translational Neuro- and Behavioral Scienes (C-TNBS), University Hospital Essen, Essen, Germany
| | - Mark Stettner
- Department of Neurology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Center for Translational Neuro- and Behavioral Scienes (C-TNBS), University Hospital Essen, Essen, Germany
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Moreira J, Martins H, Saraiva M, Saraiva MJ. TLR2 and 4 signaling pathways are altered in macrophages from V30M TTR mice with down-regulated expression of chemokines. Clin Sci (Lond) 2023; 137:355-366. [PMID: 36852978 DOI: 10.1042/cs20220656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/15/2023] [Accepted: 02/28/2023] [Indexed: 03/01/2023]
Abstract
Hereditary amyloid transthyretin (ATTRv) amyloidosis is a fatal neurodegenerative disorder, first identified in Portugal. The most common transthyretin (TTR) mutation in ATTRv results from an exchange of a methionine for a valine at position 30 (V30M). ATTRv is characterized by the extracellular deposition of aggregates and fibrils of mutant forms of TTR, particularly in the nerves and ganglia of the peripheral nervous system (PNS). This phenotype is often accompanied by the lack of inflammatory infiltrates, despite the importance of macrophages in removal of TTR deposits in ATTRv patients. The mechanisms underlying this impairment of inflammatory responses in ATTRv patients are poorly understood. Here, we show a significant down-regulation in the expression of several chemokines by bone marrow-derived macrophages (BMDM) generated from V30M TTR mice upon stimulation with toll-like receptor 4 (TLR4) and TLR2 agonists. The phosphorylation of the MAP kinase p38, important for TLR4 and TLR2 signaling pathways, was also down-regulated in V30M macrophages, as compared with wild-type (WT) ones. The present study contributes with new insights to unravel the molecular mechanisms underlying the lack of inflammatory immune responses observed in ATTRv patients and may help in the development of new immune therapeutic strategies for the disease.
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Affiliation(s)
- João Moreira
- Molecular Neurobiology Group, i3S - Instituto de Investigação e Inovação em Saúde, Department of Neurobiology and Neurologic Disorders, IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, 4200-135 Porto, Portugal
- ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Department of Molecular Biology, Universidade do Porto, 4050-313 Porto, Portugal
| | - Helena Martins
- Molecular Neurobiology Group, i3S - Instituto de Investigação e Inovação em Saúde, Department of Neurobiology and Neurologic Disorders, IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, 4200-135 Porto, Portugal
| | - Margarida Saraiva
- Immune Regulation Group, i3S - Instituto de Investigação e Inovação em Saúde, Department of Infection, Immunity,and Regeneration, IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, 4200-135 Porto, Portugal
| | - Maria João Saraiva
- Molecular Neurobiology Group, i3S - Instituto de Investigação e Inovação em Saúde, Department of Neurobiology and Neurologic Disorders, IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, 4200-135 Porto, Portugal
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Wollenweber T, Kretschmer-Chott E, Wurm R, Rasul S, Kulterer O, Rettl R, Duca F, Bonderman D, Sühs KW, Hacker M, Traub-Weidinger T. Does [99mTc]-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) soft tissue uptake allow the identification of patients with the diagnosis of cardiac transthyretin-related (ATTR) amyloidosis with higher risk for polyneuropathy? J Nucl Cardiol 2023; 30:357-367. [PMID: 35817943 PMCID: PMC9984356 DOI: 10.1007/s12350-022-02986-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/26/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND With the introduction of several drugs for the therapy of transthyretin-related amyloidosis (ATTR) which slow down the disease, early detection of polyneuropathy (PNP) is becoming increasingly of interest. [99mTc]-3,3-Diphosphono-1,2-Propanodicarboxylic Acid (DPD) bone scintigraphy, which is used for the diagnosis of cardiac (c)ATTR, can possibly make an important contribution in the identification of patients at risk for PNP. METHODS Fifty patients with cATTR, who underwent both planar whole-body DPD scintigraphy and nerve conduction studies (NCS) were retrospectively evaluated. A subgroup of 22 patients also underwent quantitative SPECT/CT of the thorax from which Standardized Uptake Values (SUVpeak) in the subcutaneous fat tissue of the left axillar region were evaluated. RESULTS The Perugini score was significantly increased in patients with cATTR and additional diagnosis of PNP compared to patients without (2.51 ± 0.51 vs 2.13 ± 0.52; P = 0.03). Quantitative SPECT/CT revealed that DPD uptake in the subcutaneous fat of the left axillar region was significantly increased in cATTR patients with compared to patients without (1.36 ± 0.60 vs 0.74 ± 0.52; P = 0.04). CONCLUSION This study suggests that DPD bone scintigraphy is a useful tool for identification of patients with cATTR and a risk for PNP due to increased DPD soft tissue uptake.
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Affiliation(s)
- Tim Wollenweber
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Kretschmer-Chott
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Raphael Wurm
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Sazan Rasul
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Oana Kulterer
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Rene Rettl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Franz Duca
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Diana Bonderman
- 5th Medical Department with Cardiology, Clinic Favoriten, Vienna, Austria
| | | | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
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Brannagan TH, Berk JL, Gillmore JD, Maurer MS, Waddington‐Cruz M, Fontana M, Masri A, Obici L, Brambatti M, Baker BF, Hannan LA, Buchele G, Viney NJ, Coelho T, Nativi‐Nicolau J. Liver-directed drugs for transthyretin-mediated amyloidosis. J Peripher Nerv Syst 2022; 27:228-237. [PMID: 36345805 PMCID: PMC10100204 DOI: 10.1111/jns.12519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 11/11/2022]
Abstract
Transthyretin-mediated amyloidosis (ATTR) is a rare, under-recognized, progressively debilitating, fatal disease caused by the aggregation and extracellular deposition of amyloid transthyretin (TTR) fibrils in multiple organs and tissues throughout the body. TTR is predominantly synthesized by the liver and normally circulates as a homotetramer, while misfolded monomers aggregate to form amyloid fibrils. One strategy to treat ATTR amyloidosis is to reduce the amount of TTR produced by the liver using drugs that directly target the TTR mRNA or gene. This narrative review focuses on how TTR gene silencing tools act to reduce TTR production, describing strategies for improved targeted delivery of these agents to hepatocytes where TTR is preferentially expressed. Antisense oligonucleotides (ASOs) and small interfering RNAs (siRNAs), termed RNA silencers, cause selective degradation of TTR mRNA, while a TTR gene editing tool reduces TTR expression by introducing nonsense mutations into the TTR gene. Two strategies to facilitate tissue-specific delivery of these nucleic acid-based drugs employ endogenous receptors expressed by hepatocytes. Lipid nanoparticles (LNPs) that recruit apolipoprotein E support low-density lipoprotein receptor-mediated uptake of unconjugated siRNA and are now used for CRISPR gene editing tools. Additionally, conjugating N-acetylgalactosamine (GalNAc) moieties to ASOs or siRNAs facilitates receptor-mediated uptake by the asialoglycoprotein receptor. In summary, ATTR is a progressive disease with various clinical manifestations due to TTR aggregation, deposition, and amyloid formation. Receptor-targeted ligands (eg, GalNAc) and nanoparticle encapsulation (eg, LNPs) are technologies to deliver ASOs, siRNAs, and gene editing tools to hepatocytes, the primary location of TTR synthesis.
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Affiliation(s)
- Thomas H. Brannagan
- Peripheral Neuropathy CenterColumbia University, Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - John L. Berk
- Amyloidosis CenterBoston University School of MedicineBostonMassachusettsUSA
| | - Julian D. Gillmore
- National Amyloidosis CentreUniversity College London, Royal Free HospitalLondonUK
| | - Mathew S. Maurer
- Cardiac Amyloidosis Program, Division of CardiologyColumbia College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Márcia Waddington‐Cruz
- National Amyloidosis Referral Center‐CEPARMUniversity HospitalFederal University of Rio de JaneiroRio de JaneiroBrazil
| | - Marianna Fontana
- National Amyloidosis CentreUniversity College London, Royal Free HospitalLondonUK
| | - Ahmad Masri
- Cardiac Amyloidosis Program, Knight Cardiovascular InstituteOregon Health & Science UniversityPortlandOregonUSA
| | - Laura Obici
- Amyloidosis Research and Treatment CenterIRCCS Fondazione Policlinico San MatteoPaviaItaly
| | | | | | | | | | | | - Teresa Coelho
- Department of NeurosciencesCentro Hospitalar Universitário do PortoPortoPortugal
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Sousa M. Preimplantation genetic testing for familial amyloid polyneuropathy. Reprod Health 2022; 19:210. [PMID: 36401333 PMCID: PMC9675164 DOI: 10.1186/s12978-022-01491-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 08/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background Embryo selection in Familial amyloid polyneuropathy eradicates the disease, but the widespread application of preimplantation genetic testing (PGT) for this monogenic disease still requires greater political and clinical commitment. Main body Familial amyloid polyneuropathy is a fatal, chronic, hereditary autosomal dominant neurodegenerative disorder caused by a single nucleotide mutation in the transthyretin gene. The disease courses with infertility, cachexia, blindness, renal failure, cardiovascular collapse, and premature death. Treatments include organ transplantation, transthyretin stabilizers, silencers and gene editing. Unfortunately, these treatments only improve the patient’s quality of life. Short conclusion The application of PGT would prevent the disease, the birth of children with this devastating disease and the enormous health costs associated. For PGT to become the first reproductive option for patients, a paradigm shift in governmental, social and medical policies is necessary.
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Juranek J, Mukherjee K, Kordas B, Załęcki M, Korytko A, Zglejc-Waszak K, Szuszkiewicz J, Banach M. Role of RAGE in the Pathogenesis of Neurological Disorders. Neurosci Bull 2022; 38:1248-1262. [PMID: 35729453 PMCID: PMC9554177 DOI: 10.1007/s12264-022-00878-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/03/2022] [Indexed: 11/30/2022] Open
Abstract
This review reflects upon our own as well as other investigators' studies on the role of receptor for advanced glycation end-products (RAGE), bringing up the latest information on RAGE in physiology and pathology of the nervous system. Over the last ten years, major progress has been made in uncovering many of RAGE-ligand interactions and signaling pathways in nervous tissue; however, the translation of these discoveries into clinical practice has not come to fruition yet. This is likely, in part to be the result of our incomplete understanding of this crucial signaling pathway. Clinical trials examining the therapeutic efficacy of blocking RAGE-external ligand interactions by genetically engineered soluble RAGE or an endogenous RAGE antagonist, has not stood up to its promise; however, other trials with different blocking agents are being considered with hope for therapeutic success in diseases of the nervous system.
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Affiliation(s)
- Judyta Juranek
- Department of Human Physiology and Pathophysiology, School of Medicine, University of Warmia and Mazury, 10-085, Olsztyn, Poland.
| | - Konark Mukherjee
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Blacksburg, VA, 24016, USA
| | - Bernard Kordas
- Department of Human Physiology and Pathophysiology, School of Medicine, University of Warmia and Mazury, 10-085, Olsztyn, Poland
| | - Michał Załęcki
- Department of Animal Anatomy, Faculty of Veterinary Medicine, University of Warmia and Mazury, 10-719, Olsztyn, Poland
| | - Agnieszka Korytko
- Department of Human Physiology and Pathophysiology, School of Medicine, University of Warmia and Mazury, 10-085, Olsztyn, Poland
| | - Kamila Zglejc-Waszak
- Department of Human Physiology and Pathophysiology, School of Medicine, University of Warmia and Mazury, 10-085, Olsztyn, Poland
| | - Jarosław Szuszkiewicz
- Department of Materials and Machines Technology, Faculty of Technical Sciences, University of Warmia and Mazury, 10-719, Olsztyn, Poland
| | - Marta Banach
- Department of Neurology, Collegium Medicum, Jagiellonian University, 31-008, Kraków, Poland.
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Cambieri C, Libonati L, Moret F, Tartaglia G, Garibaldi M, Chimenti C, Inghilleri M, Ceccanti M. The Silent Period for Small Fiber Sensory Neuropathy Assessment in a Mixed Cohort of Transthyretin-Mediated Amyloidosis. Biomedicines 2022; 10:biomedicines10092073. [PMID: 36140174 PMCID: PMC9495326 DOI: 10.3390/biomedicines10092073] [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: 07/11/2022] [Revised: 08/20/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Transthyretin-mediated amyloidosis (ATTR) is a rare multisystemic disease involving the peripheral nervous system and heart. Autonomic and small fiber involvement is one of the hallmarks of ATTR, and many tools have been proposed to assess this aspect. Aim: The aim of this study was to investigate cutaneous and mixed nerve silent periods (CSP and MnSP) as instruments for small fiber assessment. Methods: A total of 21 ATTR patients, 20 healthy controls, and 18 asymptomatic carriers underwent a sensory conduction study from the right sural and non-dominant ulnar nerves. A motor conduction study from the right deep peroneal and non-dominant ulnar nerves, with their F waves, CSPs, and MnSPs, was performed. Results: The amplitudes of the sural and ulnar sensory nerves and of the peroneal and ulnar motor nerves were reduced in ATTR patients compared to the other groups. F waves from the ulnar and peroneal nerves showed no differences between the three groups. The CSP and MnSP latency, but not amplitude, were increased in both the ulnar and peroneal nerves of ATTR patients. Conclusions: ATTR patients showed axonal involvement of large sensory and motor nerve fibers and demyelinating features of small sensory fibers.
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Affiliation(s)
- Chiara Cambieri
- Center for Rare Neuromuscular Diseases, Department of Human Neuroscience, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy
| | - Laura Libonati
- Center for Rare Neuromuscular Diseases, Department of Human Neuroscience, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy
| | - Federica Moret
- Center for Rare Neuromuscular Diseases, Department of Human Neuroscience, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy
| | - Giorgio Tartaglia
- Center for Rare Neuromuscular Diseases, Department of Human Neuroscience, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy
| | - Matteo Garibaldi
- Neuromuscular and Rare Disease Center, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Cristina Chimenti
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Sapienza University, 00185 Rome, Italy
- Cellular and Molecular Cardiology Lab, IRCCS Lazzaro Spallanzani, 00149 Rome, Italy
| | - Maurizio Inghilleri
- Center for Rare Neuromuscular Diseases, Department of Human Neuroscience, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy
| | - Marco Ceccanti
- Center for Rare Neuromuscular Diseases, Department of Human Neuroscience, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy
- Correspondence:
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Nakano T, Onoue K, Terada C, Terasaki S, Ishihara S, Hashimoto Y, Nakada Y, Nakagawa H, Ueda T, Seno A, Nishida T, Watanabe M, Hoshii Y, Hatakeyama K, Sakaguchi Y, Ohbayashi C, Saito Y. Transthyretin Amyloid Cardiomyopathy: Impact of Transthyretin Amyloid Deposition in Myocardium on Cardiac Morphology and Function. J Pers Med 2022; 12:jpm12050792. [PMID: 35629214 PMCID: PMC9147607 DOI: 10.3390/jpm12050792] [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: 03/11/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Transthyretin (TTR) amyloid cardiomyopathy (ATTR-CM) is increasingly being recognized as a cause of left ventricular (LV) hypertrophy (LVH) and progressive heart failure in elderly patients. However, little is known about the cardiac morphology of ATTR-CM and the association between the degree of TTR amyloid deposition and cardiac dysfunction in these patients. Methods: We studied 28 consecutive patients with ATTR-CM and analyzed the relationship between echocardiographic parameters and pathological features using endomyocardial biopsy samples. Results: The cardiac geometries of patients with ATTR-CM were mainly classified as concentric LVH (96.4%). The relative wall thickness, a marker of LVH, tended to be positively correlated with the degree of non-cardiomyocyte area. The extent of TTR deposition was positively correlated with enlargement of the non-cardiomyocyte area, and these were positively correlated with LV diastolic dysfunction. Additionally, the extent of the area containing TTR was positively correlated with the percentage of cardiomyocyte nuclei stained for 8-hydroxy-2′deoxyguanosine, a marker of reactive oxygen species (ROS). ROS accumulation in cardiomyocytes was positively correlated with LV systolic dysfunction. Conclusion: Patients with ATTR-CM mainly displayed concentric LVH geometry. TTR amyloid deposition was associated with cardiac dysfunction via increased non-cardiomyocyte area and ROS accumulation in cardiomyocytes.
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Affiliation(s)
- Tomoya Nakano
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara 634-8521, Nara, Japan; (T.N.); (S.T.); (S.I.); (Y.H.); (Y.N.); (H.N.); (T.U.); (A.S.); (T.N.); (M.W.); (Y.S.); (Y.S.)
- Department of Cardiovascular Medicine, Yamato Takada Municipal Hospital, Yamato-Takada 635-8501, Nara, Japan
| | - Kenji Onoue
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara 634-8521, Nara, Japan; (T.N.); (S.T.); (S.I.); (Y.H.); (Y.N.); (H.N.); (T.U.); (A.S.); (T.N.); (M.W.); (Y.S.); (Y.S.)
- Correspondence: ; Tel.: +81-744-22-3051
| | - Chiyoko Terada
- Department of Diagnostic Pathology, Nara Medical University, Kashihara 634-8521, Nara, Japan; (C.T.); (C.O.)
| | - Satoshi Terasaki
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara 634-8521, Nara, Japan; (T.N.); (S.T.); (S.I.); (Y.H.); (Y.N.); (H.N.); (T.U.); (A.S.); (T.N.); (M.W.); (Y.S.); (Y.S.)
| | - Satomi Ishihara
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara 634-8521, Nara, Japan; (T.N.); (S.T.); (S.I.); (Y.H.); (Y.N.); (H.N.); (T.U.); (A.S.); (T.N.); (M.W.); (Y.S.); (Y.S.)
| | - Yukihiro Hashimoto
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara 634-8521, Nara, Japan; (T.N.); (S.T.); (S.I.); (Y.H.); (Y.N.); (H.N.); (T.U.); (A.S.); (T.N.); (M.W.); (Y.S.); (Y.S.)
| | - Yasuki Nakada
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara 634-8521, Nara, Japan; (T.N.); (S.T.); (S.I.); (Y.H.); (Y.N.); (H.N.); (T.U.); (A.S.); (T.N.); (M.W.); (Y.S.); (Y.S.)
| | - Hitoshi Nakagawa
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara 634-8521, Nara, Japan; (T.N.); (S.T.); (S.I.); (Y.H.); (Y.N.); (H.N.); (T.U.); (A.S.); (T.N.); (M.W.); (Y.S.); (Y.S.)
| | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara 634-8521, Nara, Japan; (T.N.); (S.T.); (S.I.); (Y.H.); (Y.N.); (H.N.); (T.U.); (A.S.); (T.N.); (M.W.); (Y.S.); (Y.S.)
| | - Ayako Seno
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara 634-8521, Nara, Japan; (T.N.); (S.T.); (S.I.); (Y.H.); (Y.N.); (H.N.); (T.U.); (A.S.); (T.N.); (M.W.); (Y.S.); (Y.S.)
| | - Taku Nishida
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara 634-8521, Nara, Japan; (T.N.); (S.T.); (S.I.); (Y.H.); (Y.N.); (H.N.); (T.U.); (A.S.); (T.N.); (M.W.); (Y.S.); (Y.S.)
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara 634-8521, Nara, Japan; (T.N.); (S.T.); (S.I.); (Y.H.); (Y.N.); (H.N.); (T.U.); (A.S.); (T.N.); (M.W.); (Y.S.); (Y.S.)
| | - Yoshinobu Hoshii
- Department of Diagnostic Pathology, Yamaguchi University Hospital, Ube 755-0046, Yamaguchi, Japan;
| | - Kinta Hatakeyama
- Department of Pathology, National Cerebral and Cardiovascular Center, Suita 564-8565, Osaka, Japan;
| | - Yasuhiro Sakaguchi
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara 634-8521, Nara, Japan; (T.N.); (S.T.); (S.I.); (Y.H.); (Y.N.); (H.N.); (T.U.); (A.S.); (T.N.); (M.W.); (Y.S.); (Y.S.)
| | - Chiho Ohbayashi
- Department of Diagnostic Pathology, Nara Medical University, Kashihara 634-8521, Nara, Japan; (C.T.); (C.O.)
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara 634-8521, Nara, Japan; (T.N.); (S.T.); (S.I.); (Y.H.); (Y.N.); (H.N.); (T.U.); (A.S.); (T.N.); (M.W.); (Y.S.); (Y.S.)
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11
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Thimm A, Carpinteiro A, Oubari S, Papathanasiou M, Kessler L, Rischpler C, Malik RA, Reinhardt HC, Rassaf T, Herrmann K, Kleinschnitz C, Stettner M, Hagenacker T. Corneal confocal microscopy to detect early immune-mediated small nerve fibre loss in AL amyloidosis. Ann Clin Transl Neurol 2022; 9:853-863. [PMID: 35488792 PMCID: PMC9186132 DOI: 10.1002/acn3.51565] [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: 02/10/2022] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Light chain (AL) amyloidosis is a life‐threatening disorder characterised by extracellular deposition of amyloid leading to dysfunction of multiple organs. Peripheral nerve involvement, particularly small fibre neuropathy, may be associated with poorer survival. Corneal confocal microscopy (CCM) is a rapid and non‐invasive imaging technique to quantify corneal small nerve fibres and immune cells in vivo. We aimed to evaluate CCM as a tool for early diagnosis of peripheral nerve involvement in AL amyloidosis. Methods CCM and nerve conduction studies (NCS) were undertaken in 21 newly diagnosed, treatment‐naïve AL amyloidosis patients and 21 age‐ and sex‐matched healthy controls. Corneal nerve fibre density (CNFD), corneal nerve branch density and fibre length, and cell infiltrates were quantified in the sub‐basal layer of the cornea. Results There was a significant reduction in CNFD and nerve fibre length, even without large fibre affection and an increase in cell density, particularly around corneal nerve fibres in patients with AL amyloidosis compared to controls. Additionally, cell infiltration correlated with reduced nerve fibre density in patients with AL amyloidosis, but reduced CNFD did not correlate with laboratory parameters of organ dysfunction. Interpretation Our study is the first to show that CCM allows rapid non‐invasive identification of early small nerve fibre damage associated with immune cell infiltration in patients with AL amyloidosis. CCM detects peripheral nerve involvement more sensitively than NCS.
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Affiliation(s)
- Andreas Thimm
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - Alexander Carpinteiro
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, Essen, Germany.,Institute of Molecular Biology, University of Duisburg-Essen, Essen, Germany
| | - Sara Oubari
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, Essen, Germany
| | - Maria Papathanasiou
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Lukas Kessler
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | | | - Rayaz Ahmed Malik
- Institute of Cardiovascular Science, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.,Weill Cornell Medicine-Qatar, Education City, Doha, Qatar
| | - Hans Christian Reinhardt
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - Mark Stettner
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - Tim Hagenacker
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
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12
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Papendorf JJ, Krüger E, Ebstein F. Proteostasis Perturbations and Their Roles in Causing Sterile Inflammation and Autoinflammatory Diseases. Cells 2022; 11:cells11091422. [PMID: 35563729 PMCID: PMC9103147 DOI: 10.3390/cells11091422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/04/2022] [Accepted: 04/14/2022] [Indexed: 12/17/2022] Open
Abstract
Proteostasis, a portmanteau of the words protein and homeostasis, refers to the ability of eukaryotic cells to maintain a stable proteome by acting on protein synthesis, quality control and/or degradation. Over the last two decades, an increasing number of disorders caused by proteostasis perturbations have been identified. Depending on their molecular etiology, such diseases may be classified into ribosomopathies, proteinopathies and proteasomopathies. Strikingly, most—if not all—of these syndromes exhibit an autoinflammatory component, implying a direct cause-and-effect relationship between proteostasis disruption and the initiation of innate immune responses. In this review, we provide a comprehensive overview of the molecular pathogenesis of these disorders and summarize current knowledge of the various mechanisms by which impaired proteostasis promotes autoinflammation. We particularly focus our discussion on the notion of how cells sense and integrate proteostasis perturbations as danger signals in the context of autoinflammatory diseases to provide insights into the complex and multiple facets of sterile inflammation.
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13
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Magalhães J, Eira J, Liz MA. The role of transthyretin in cell biology: impact on human pathophysiology. Cell Mol Life Sci 2021; 78:6105-6117. [PMID: 34297165 PMCID: PMC11073172 DOI: 10.1007/s00018-021-03899-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/08/2021] [Accepted: 07/09/2021] [Indexed: 01/29/2023]
Abstract
Transthyretin (TTR) is an extracellular protein mainly produced in the liver and choroid plexus, with a well-stablished role in the transport of thyroxin and retinol throughout the body and brain. TTR is prone to aggregation, as both wild-type and mutated forms of the protein can lead to the accumulation of amyloid deposits, resulting in a disease called TTR amyloidosis. Recently, novel activities for TTR in cell biology have emerged, ranging from neuronal health preservation in both central and peripheral nervous systems, to cellular fate determination, regulation of proliferation and metabolism. Here, we review the novel literature regarding TTR new cellular effects. We pinpoint TTR as major player on brain health and nerve biology, activities that might impact on nervous systems pathologies, and assign a new link between TTR and angiogenesis and cancer. We also explore the molecular mechanisms underlying TTR activities at the cellular level, and suggest that these might go beyond its most acknowledged carrier functions and include interaction with receptors and activation of intracellular signaling pathways.
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Affiliation(s)
- Joana Magalhães
- Neurodegeneration Team, Nerve Regeneration Group, IBMC - Instituto de Biologia Molecular e Celular and i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Jessica Eira
- Neurodegeneration Team, Nerve Regeneration Group, IBMC - Instituto de Biologia Molecular e Celular and i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade Do Porto, Porto, Portugal
| | - Márcia Almeida Liz
- Neurodegeneration Team, Nerve Regeneration Group, IBMC - Instituto de Biologia Molecular e Celular and i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.
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14
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Tozza S, Severi D, Spina E, Iovino A, Aruta F, Ruggiero L, Dubbioso R, Iodice R, Nolano M, Manganelli F. The neuropathy in hereditary transthyretin amyloidosis: A narrative review. J Peripher Nerv Syst 2021; 26:155-159. [PMID: 33960565 PMCID: PMC8360044 DOI: 10.1111/jns.12451] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/26/2021] [Accepted: 05/01/2021] [Indexed: 01/10/2023]
Abstract
Hereditary transthyretin amyloidosis (ATTRv) is a condition with adult onset, caused by mutation of the transthyretin (TTR) gene and characterized by extracellular deposition of amyloid fibrils in tissue, especially in the peripheral nervous system (PNS) and heart. PNS involvement leads to a rapidly progressive and disabling sensory‐motor axonal neuropathy. Although awareness among neurologists increased in recent years thanks to new treatment options, ATTRv is frequently misdiagnosed, and thus a correct diagnosis can be delayed by several years. This review aims to draw the history and features of polyneuropathy in ATTRv based on pathological and electrophysiological correlates. We assessed original articles and case reports based on their relevance to ATTRv neuropathy and we included those appropriate for the scheme of this narrative review. Amyloid fibrils initially deposit in ganglia, causing an axonal neuropathy without amyloid deposits in distal segments (eg, sural nerve biopsy). Over time, amyloid fibrils spread along the nerves, leading to some demyelinating features in the context of severe axonal loss. This review highlights how the features of neuropathy change based on type of ATTRv (early vs late onset) and stage of disease.
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Affiliation(s)
- Stefano Tozza
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Daniele Severi
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Emanuele Spina
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Aniello Iovino
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Francesco Aruta
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Lucia Ruggiero
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Raffaele Dubbioso
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Rosa Iodice
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Maria Nolano
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Fiore Manganelli
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
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15
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Physiological Metals Can Induce Conformational Changes in Transthyretin Structure: Neuroprotection or Misfolding Induction? CRYSTALS 2021. [DOI: 10.3390/cryst11040354] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Transthyretin (TTR) is a plasma homotetrameric protein that transports thyroxine and retinol. TTR itself, under pathological conditions, dissociates into partially unfolded monomers that aggregate and form fibrils. Metal ions such as Zn2+, Cu2+, Fe2+, Mn2+ and Ca2+ play a controversial role in the TTR amyloidogenic pathway. TTR is also present in cerebrospinal fluid (CSF), where it behaves as one of the major Aβ-binding-proteins. The interaction between TTR and Aβ is stronger in the presence of high concentrations of Cu2+. Crystals of TTR, soaked in solutions of physiological metals such as Cu2+ and Fe2+, but not Mn2+, Zn2+, Fe3+, Al3+, Ni2+, revealed an unusual conformational change. Here, we investigate the effects that physiological metals have on TTR, in order to understand if metals can induce a specific and active conformation of TTR that guides its Aβ-scavenging role. The capability of certain metals to induce and accelerate its amyloidogenic process is also discussed.
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16
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Bradley AE, Bolon B, Butt MT, Cramer SD, Czasch S, Garman RH, George C, Gröters S, Kaufmann W, Kovi RC, Krinke G, Little PB, Narama I, Rao DB, Sharma AK, Shibutani M, Sills R. Proliferative and Nonproliferative Lesions of the Rat and Mouse Central and Peripheral Nervous Systems: New and Revised INHAND Terms. Toxicol Pathol 2020; 48:827-844. [PMID: 32912053 DOI: 10.1177/0192623320951154] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Harmonization of diagnostic terminology used during the histopathologic analysis of rodent tissue sections from nonclinical toxicity studies will improve the consistency of data sets produced by laboratories located around the world. The INHAND Project (International Harmonization of Nomenclature and Diagnostic Criteria for Lesions in Rats and Mice) is a cooperative enterprise of 4 major societies of toxicologic pathology to develop a globally accepted standard vocabulary for proliferative and nonproliferative lesions in rodents. A prior manuscript (Toxicol Pathol 2012;40[4 Suppl]:87S-157S) defined multiple diagnostic terms for toxicant-induced lesions, common spontaneous and age-related changes, and principal confounding artifacts in the rat and mouse central nervous system (CNS) and peripheral nervous system (PNS). The current article defines 9 new diagnostic terms and updates 2 previous terms for findings in the rodent CNS and PNS, the need for which has become evident in the years since the publication of the initial INHAND nomenclature for findings in rodent neural tissues. The nomenclature presented in this document is also available electronically on the Internet at the goRENI website (http://www.goreni.org/).
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Affiliation(s)
- Alys E Bradley
- 57146Charles River Laboratories Edinburgh Ltd., Tranent, United Kingdom
| | | | - Mark T Butt
- Tox Path Specialists, LLC, Frederick, MD, USA
| | | | | | - Robert H Garman
- Consultants in Veterinary Pathology, Inc., Murrysville, PA, USA
| | | | | | | | - Ramesh C Kovi
- Experimental Pathology Laboratories (EPL), Inc., Research Triangle Park, NC, USA.,National Toxicology Program (NTP), US National Institute of Environmental Health Sciences (NIEHS), Research Triangle Park, NC, USA
| | | | - Peter B Little
- Experimental Pathology Laboratories (EPL), Inc., Durham, NC, USA
| | - Isao Narama
- 92109BioSafety Research Center, Inc. (BSRC), Iwata, Japan
| | - Deepa B Rao
- Tox Path Specialists, LLC, Frederick, MD, USA
| | | | - Makoto Shibutani
- Tokyo University of Agriculture and Technology, Laboratory of Veterinary Pathology, Tokyo, Japan
| | - Robert Sills
- National Toxicology Program (NTP), US National Institute of Environmental Health Sciences (NIEHS), Research Triangle Park, NC, USA
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17
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Asiri MMH, Engelsman S, Eijkelkamp N, Höppener JWM. Amyloid Proteins and Peripheral Neuropathy. Cells 2020; 9:E1553. [PMID: 32604774 PMCID: PMC7349787 DOI: 10.3390/cells9061553] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 12/14/2022] Open
Abstract
Painful peripheral neuropathy affects millions of people worldwide. Peripheral neuropathy develops in patients with various diseases, including rare familial or acquired amyloid polyneuropathies, as well as some common diseases, including type 2 diabetes mellitus and several chronic inflammatory diseases. Intriguingly, these diseases share a histopathological feature-deposits of amyloid-forming proteins in tissues. Amyloid-forming proteins may cause tissue dysregulation and damage, including damage to nerves, and may be a common cause of neuropathy in these, and potentially other, diseases. Here, we will discuss how amyloid proteins contribute to peripheral neuropathy by reviewing the current understanding of pathogenic mechanisms in known inherited and acquired (usually rare) amyloid neuropathies. In addition, we will discuss the potential role of amyloid proteins in peripheral neuropathy in some common diseases, which are not (yet) considered as amyloid neuropathies. We conclude that there are many similarities in the molecular and cell biological defects caused by aggregation of the various amyloid proteins in these different diseases and propose a common pathogenic pathway for "peripheral amyloid neuropathies".
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Affiliation(s)
- Mohammed M. H. Asiri
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, 3584 EA Utrecht, The Netherlands; (M.M.H.A.); (S.E.); (J.W.M.H.)
- The National Centre for Genomic Technology, Life Science and Environment Research Institute, King Abdulaziz City for Science and Technology, P.O. Box 6086, 11461 Riyadh, Saudi Arabia
| | - Sjoukje Engelsman
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, 3584 EA Utrecht, The Netherlands; (M.M.H.A.); (S.E.); (J.W.M.H.)
| | - Niels Eijkelkamp
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, 3584 EA Utrecht, The Netherlands; (M.M.H.A.); (S.E.); (J.W.M.H.)
| | - Jo W. M. Höppener
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, 3584 EA Utrecht, The Netherlands; (M.M.H.A.); (S.E.); (J.W.M.H.)
- Center for Molecular Medicine, University Medical Center Utrecht, Utrecht University, 3584 EA Utrecht, The Netherlands
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18
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Uncovering the Neuroprotective Mechanisms of Curcumin on Transthyretin Amyloidosis. Int J Mol Sci 2019; 20:ijms20061287. [PMID: 30875761 PMCID: PMC6471102 DOI: 10.3390/ijms20061287] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/02/2019] [Accepted: 03/07/2019] [Indexed: 02/07/2023] Open
Abstract
Transthyretin (TTR) amyloidoses (ATTR amyloidosis) are diseases associated with transthyretin (TTR) misfolding, aggregation and extracellular deposition in tissues as amyloid. Clinical manifestations of the disease are variable and include mainly polyneuropathy and/or cardiomyopathy. The reasons why TTR forms aggregates and amyloid are related with amino acid substitutions in the protein due to mutations, or with environmental alterations associated with aging, that make the protein more unstable and prone to aggregation. According to this model, several therapeutic approaches have been proposed for the diseases that range from stabilization of TTR, using chemical chaperones, to clearance of the aggregated protein deposited in tissues in the form of oligomers or small aggregates, by the action of disruptors or by activation of the immune system. Interestingly, different studies revealed that curcumin presents anti-amyloid properties, targeting multiple steps in the ATTR amyloidogenic cascade. The effects of curcumin on ATTR amyloidosis will be reviewed and discussed in the current work in order to contribute to knowledge of the molecular mechanisms involved in TTR amyloidosis and propose more efficient drugs for therapy.
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19
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Dias A, Santos D, Coelho T, Alves-Ferreira M, Sequeiros J, Alonso I, Sousa A, Lemos C. C1QA and C1QC modify age-at-onset in familial amyloid polyneuropathy patients. Ann Clin Transl Neurol 2019; 6:748-754. [PMID: 31019999 PMCID: PMC6469251 DOI: 10.1002/acn3.748] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 11/24/2022] Open
Abstract
Objectives Transthyretin (TTR) familial amyloid polyneuropathy (FAP) (OMIM 176300) shows a variable age‐at‐onset (AO), including within families. We hypothesized that variants in C1QA and C1QC genes, might also act as genetic modifiers of AO in TTR‐FAP Val30Met Portuguese patients. Methods We analyzed DNA samples of 267 patients (117 families). To search for variants, all exons and flanking regions were genotyped by automated sequencing. We used generalized estimating equations (GEEs) to take into account the non‐independency of AO among relatives. Intensive in silico analyses were performed, using various software to assess miRNAs target sites, splicing sites, transcription factor binding sites alterations, and gene–gene interactions. Results Two variants for C1QA gene, GA genotype of rs201693493 (P < 0.001) and CT genotype of rs149050968 (P < 0.001), were significantly associated with later AO. In silico analysis demonstrated, that rs201693493 may alter splicing activity. Regarding C1QC, we found three statistically significant results: GA genotype of rs2935537 (P = 0.003), GA genotype of rs201241346 (P < 0.001) and GA genotype of rs200952686 (P < 0.001). The first two were associated with earlier AO, whereas the third was associated with later‐onset. Interpretation C1QA was associated with later onset, whereas C1QC may have a double role: variants may confer earlier or later AO. As found in a study in Cyprus, we confirmed the role of complement C1Q genes (and thus of inflammation) as modulator of AO in Portuguese patients with TTR‐FAP Val30Met.
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Affiliation(s)
- Andreia Dias
- i3S Instituto de Investigação e Inovação em Saúde Universidade do Porto Porto Portugal.,UnIGENe IBMC - Instituto de Biologia Molecular e Celular Universidade do Porto Porto Portugal.,FCUP Faculdade de Ciências da Universidade do Porto Porto Portugal
| | - Diana Santos
- i3S Instituto de Investigação e Inovação em Saúde Universidade do Porto Porto Portugal.,UnIGENe IBMC - Instituto de Biologia Molecular e Celular Universidade do Porto Porto Portugal.,ICBAS Instituto Ciências Biomédicas Abel Salazar Universidade do Porto Porto Portugal
| | - Teresa Coelho
- UCA Unidade Corino de Andrade Centro Hospitalar Universitário do Porto (CHUP) Porto Portugal
| | - Miguel Alves-Ferreira
- i3S Instituto de Investigação e Inovação em Saúde Universidade do Porto Porto Portugal.,UnIGENe IBMC - Instituto de Biologia Molecular e Celular Universidade do Porto Porto Portugal.,ICBAS Instituto Ciências Biomédicas Abel Salazar Universidade do Porto Porto Portugal
| | - Jorge Sequeiros
- i3S Instituto de Investigação e Inovação em Saúde Universidade do Porto Porto Portugal.,UnIGENe IBMC - Instituto de Biologia Molecular e Celular Universidade do Porto Porto Portugal.,ICBAS Instituto Ciências Biomédicas Abel Salazar Universidade do Porto Porto Portugal
| | - Isabel Alonso
- i3S Instituto de Investigação e Inovação em Saúde Universidade do Porto Porto Portugal.,UnIGENe IBMC - Instituto de Biologia Molecular e Celular Universidade do Porto Porto Portugal.,ICBAS Instituto Ciências Biomédicas Abel Salazar Universidade do Porto Porto Portugal
| | - Alda Sousa
- i3S Instituto de Investigação e Inovação em Saúde Universidade do Porto Porto Portugal.,UnIGENe IBMC - Instituto de Biologia Molecular e Celular Universidade do Porto Porto Portugal.,ICBAS Instituto Ciências Biomédicas Abel Salazar Universidade do Porto Porto Portugal
| | - Carolina Lemos
- i3S Instituto de Investigação e Inovação em Saúde Universidade do Porto Porto Portugal.,UnIGENe IBMC - Instituto de Biologia Molecular e Celular Universidade do Porto Porto Portugal.,ICBAS Instituto Ciências Biomédicas Abel Salazar Universidade do Porto Porto Portugal
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20
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Transthyretin Amyloid Neuropathy: The Schwann Cell Hypothesis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1190:371-378. [PMID: 31760657 DOI: 10.1007/978-981-32-9636-7_24] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Transthyretin (TTR)-familial amyloid polyneuropathy (FAP) is a systemic amyloidosis caused by mutations in the TTR gene. Typically, patients initially present with sensory and autonomic symptoms, which can lead to sensory dominant polyneuropathy and autonomic neuropathy. Mutations in TTR cause the tetrameric protein to dissociate and form amyloid deposits in the peripheral nervous system, most prominently in dorsal root ganglia (DRG), autonomic ganglia, and nerve trunks. Teased fiber studies have shown that segmental demyelination and axonal degeneration preferentially occur in the proximal and distal regions of the peripheral nerves, respectively. Nevertheless, it remains unknown why genetic variants of TTR lead to neurodegeneration in the peripheral nervous system. Recent studies in our laboratory have uncovered an important role for Schwann cells in the disease progression of FAP. In this review, we summarize findings implicating Schwann cells in FAP, and provide evidence that DRG may serve as the initial site of lesion formation in the disease.
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21
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Ramalho TC, de Castro AA, Tavares TS, Silva MC, Silva DR, Cesar PH, Santos LA, da Cunha EFF, Nepovimova E, Kuca K. Insights into the pharmaceuticals and mechanisms of neurological orphan diseases: Current Status and future expectations. Prog Neurobiol 2018; 169:135-157. [PMID: 29981392 DOI: 10.1016/j.pneurobio.2018.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 06/30/2018] [Indexed: 12/20/2022]
Abstract
Several rare or orphan diseases have been characterized that singly affect low numbers of people, but cumulatively reach ∼6%-10% of the population in Europe and in the United States. Human genetics has shown to be broadly effective when evaluating subjacent genetic defects such as orphan genetic diseases, but on the other hand, a modest progress has been achieved toward comprehending the molecular pathologies and designing new therapies. Chemical genetics, placed at the interface of chemistry and genetics, could be employed to understand the molecular mechanisms of subjacent illnesses and for the discovery of new remediation processes. This review debates current progress in chemical genetics, and how a variety of compounds and reaction mechanisms can be used to study and ultimately treat rare genetic diseases. We focus here on a study involving Amyotrophic lateral sclerosis (ALS), Duchenne Muscular Dystrophy (DMD), Spinal muscular atrophy (SMA) and Familial Amyloid Polyneuropathy (FAP), approaching different treatment methods and the reaction mechanisms of several compounds, trying to elucidate new routes capable of assisting in the treatment profile.
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Affiliation(s)
- Teodorico C Ramalho
- Department of Chemistry, Federal University of Lavras, 37200-000, Lavras, Brazil; Center for Basic and Applied Research, Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove, Czech Republic.
| | | | - Tássia S Tavares
- Department of Chemistry, Federal University of Lavras, 37200-000, Lavras, Brazil
| | - Maria C Silva
- Department of Chemistry, Federal University of Lavras, 37200-000, Lavras, Brazil
| | - Daniela R Silva
- Department of Chemistry, Federal University of Lavras, 37200-000, Lavras, Brazil
| | - Pedro H Cesar
- Department of Chemistry, Federal University of Lavras, 37200-000, Lavras, Brazil
| | - Lucas A Santos
- Department of Chemistry, Federal University of Lavras, 37200-000, Lavras, Brazil
| | - Elaine F F da Cunha
- Department of Chemistry, Federal University of Lavras, 37200-000, Lavras, Brazil
| | - Eugenie Nepovimova
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, Hradec Kralove, Czech Republic
| | - Kamil Kuca
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, Hradec Kralove, Czech Republic.
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22
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Escolano-Lozano F, Barreiros AP, Birklein F, Geber C. Transthyretin familial amyloid polyneuropathy (TTR-FAP): Parameters for early diagnosis. Brain Behav 2018; 8:e00889. [PMID: 29568686 PMCID: PMC5853640 DOI: 10.1002/brb3.889] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/16/2017] [Accepted: 11/04/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Familial transthyretin amyloidosis is a life-threatening disease presenting with sensorimotor and autonomic polyneuropathy. Delayed diagnosis has a detrimental effect on treatment and prognosis. To facilitate diagnosis, we analyzed data patterns of patients with transthyretin familial amyloid polyneuropathy (TTR-FAP) and compared them to polyneuropathies of different etiology for clinical and electrophysiological discriminators. METHODS Twenty-four patients with TTR-FAP and 48 patients with diabetic polyneuropathy (dPNP) were investigated (neurological impairment score NIS; neurological disability score NDS) in a cross-sectional design. Both groups were matched for gender and presence of pain. Quantitative sensory testing (QST), sympathetic skin response (SSR), heart rate variability (HRV), and nerve conduction studies (NCV) were performed. Both groups were compared using univariate analysis. In a stepwise discriminant analysis, discriminators between both neuropathies were identified. These discriminators were validated comparing TTR-FAP patients with a cohort of patients with chemotherapy-induced polyneuropathy (CIN) and chronic inflammatory demyelinating neuropathy (CIDP). RESULTS TTR-FAP patients scored higher in NDS and NIS and had impaired cold detection (CDT, p = .024), cold-warm discrimination (TSL, p = .019) and mechanical hyperalgesia (MPT, p = .029) at the hands, SSR (upper limb, p = .022) HRV and ulnar and sural NCS (all p < .05) were more affected in TTR-FAP. Ulnar nerve sensory NCV, CDT, and the MPT but not the other parameters discriminated TTR-FAP from dPNP (82% of cases), from CIN (86.7%) and from CIDP (68%; only ulnar sNCV). CONCLUSION Low ulnar SNCV, impaired cold perception, and mechanical hyperalgesia at the hands seem to characterize TTR-FAP and might help to differentiate from other polyneuropathies.
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Affiliation(s)
- Fabiola Escolano-Lozano
- Department of Neurology University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
| | | | - Frank Birklein
- Department of Neurology University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
| | - Christian Geber
- Department of Neurology University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany.,Red Cross Pain Center Mainz Germany
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23
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Lopes R, Sousa M, Silva J, Cunha M, Oliveira C, Teixeira da Silva J, Ferraz L, Coelho T, Carvalho F, Barros A. Clinical outcomes after preimplantation genetic diagnosis of patients with Corino de Andrade disease (familial amyloid polyneuropathy). Reprod Biomed Online 2018; 36:39-46. [DOI: 10.1016/j.rbmo.2017.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 09/22/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
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24
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Lopes A, Fonseca I, Sousa A, Branco M, Rodrigues C, Coelho T, Sequeiros J, Freitas P. Psychopathological Dimensions in Portuguese Subjects with Transthyretin Familial Amyloid Polyneuropathy. Biomed Hub 2017; 2:1-14. [PMID: 31988916 PMCID: PMC6945894 DOI: 10.1159/000485118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 11/09/2017] [Indexed: 11/21/2022] Open
Abstract
Background Transthyretin familial amyloid polyneuropathy (TTR-FAP) is a fatal, chronic, progressive disease. It is a rare hereditary amyloidosis, which manifests as a sensorimotor neuropathy and autonomic dysfunction. It begins during adulthood. Aims and Methods Our aim is to evaluate psychopathological dimensions in a population attending a consultation center for TTR-FAP. Two hundred and nine subjects (symptomatic and asymptomatic carriers), 84 men and 127, women participated in the study. Most subjects were married (67.1%) and most of them were still working; 33% were retired from work or on a sick leave. A sociodemographic questionnaire and The Brief Symptom Inventory (BSI) were applied. Statistical analysis was performed (descriptive analysis, Mann-Whitney, Wilcoxon, and Spearman tests). Results The Global Symptom Index (GSI) was significantly higher in patients (p = 0.001). Considering GSI, 32.7% of total subjects were above the median for general population. When subgroups were evaluated, 25.6% of symptomatic carriers, 26.3% of subjects without established diagnosis, and 39.1% of patients were above median. GSI was significantly higher in patients (p = 0.001). Some BSI dimensions were also significantly higher in the patient group (somatization, depression, anxiety, and psychoticism) when compared with carriers. Women scored higher than men. Sick women scored higher for all dimensions except somatization. Asymptomatic carriers scored statistically higher for phobic anxiety (p = 0.01), interpersonal sensitivity, anxiety, and depression. In patients, most dimensions and GSI (rho = 0.33, p = 0.002) had positive correlations with years of disease. Conclusions TTR-FAP patients and carriers are a very vulnerable group for psychological distress and psychopathological problems. Women and patients are at higher risk.
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Affiliation(s)
- Alice Lopes
- Unidade Corino de Andrade, Serviço de Psiquiatria e Saúde Mental, Centro Hospitalar do Porto, Porto, Portugal.,ICBAS - Instituto de Ciências Biomédicos Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Isabel Fonseca
- Unidade Corino de Andrade, Centro Hospitalar do Porto, Porto, Portugal.,EPIUnit and Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal
| | - Alexandra Sousa
- Unidade Corino de Andrade, Centro Hospitalar do Porto, Porto, Portugal
| | - Margarida Branco
- Unidade Corino de Andrade, Serviço de Psiquiatria e Saúde Mental, Centro Hospitalar do Porto, Porto, Portugal
| | - Carla Rodrigues
- Unidade Corino de Andrade, Centro Hospitalar do Porto, Porto, Portugal
| | - Teresa Coelho
- Unidade Corino de Andrade, Serviço de Neurofisiologia, Centro Hospitalar do Porto, Porto, Portugal
| | - Jorge Sequeiros
- ICBAS - Instituto de Ciências Biomédicos Abel Salazar, Universidade do Porto, Porto, Portugal.,IBMC - Institute for Molecular and Cell Biology and i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Paula Freitas
- ICBAS - Instituto de Ciências Biomédicos Abel Salazar, Universidade do Porto, Porto, Portugal
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25
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Clinical and pathological findings in familial amyloid polyneuropathy caused by a transthyretin E61K mutation. J Neurol Sci 2017; 381:55-58. [DOI: 10.1016/j.jns.2017.08.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 08/08/2017] [Accepted: 08/10/2017] [Indexed: 12/20/2022]
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26
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Lim KH, Dasari AKR, Ma R, Hung I, Gan Z, Kelly JW, Fitzgerald MC. Pathogenic Mutations Induce Partial Structural Changes in the Native β-Sheet Structure of Transthyretin and Accelerate Aggregation. Biochemistry 2017; 56:4808-4818. [PMID: 28820582 DOI: 10.1021/acs.biochem.7b00658] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Amyloid formation of natively folded proteins involves global and/or local unfolding of the native state to form aggregation-prone intermediates. Here we report solid-state nuclear magnetic resonance (NMR) structural studies of amyloid derived from wild-type (WT) and more aggressive mutant forms of transthyretin (TTR) to investigate the structural changes associated with effective TTR aggregation. We employed selective 13C labeling schemes to investigate structural features of β-structured core regions in amyloid states of WT and two mutant forms (V30M and L55P) of TTR. Analyses of the 13C-13C correlation solid-state NMR spectra revealed that WT TTR aggregates contain an amyloid core consisting of nativelike CBEF and DAGH β-sheet structures, and the mutant TTR amyloids adopt a similar amyloid core structure with nativelike CBEF and AGH β-structures. However, the V30M mutant amyloid was shown to have a different DA β-structure. In addition, strand D is more disordered even in the native state of L55P TTR, indicating that the pathogenic mutations affect the DA β-structure, leading to more effective amyloid formation. The NMR results are consistent with our mass spectrometry-based thermodynamic analyses that showed the amyloidogenic precursor states of WT and mutant TTRs adopt folded structures but the mutant precursor states are less stable than that of WT TTR. Analyses of the oxidation rate of the methionine side chain also revealed that the side chain of residue Met-30 pointing between strands D and A is not protected from oxidation in the V30M mutant, while protected in the native state, supporting the possibility that the DA β-structure might be disrupted in the V30M mutant amyloid.
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Affiliation(s)
- Kwang Hun Lim
- Department of Chemistry, East Carolina University , Greenville, North Carolina 27858, United States
| | - Anvesh K R Dasari
- Department of Chemistry, East Carolina University , Greenville, North Carolina 27858, United States
| | - Renze Ma
- Department of Chemistry, Duke University , 124 Science Drive, Durham, North Carolina 27708-0346, United States
| | - Ivan Hung
- Center of Interdisciplinary Magnetic Resonance (CIMAR), National High Magnetic Field Laboratory (NHMFL) , 1800 East Paul Dirac Drive, Tallahassee, Florida 32310, United States
| | - Zhehong Gan
- Center of Interdisciplinary Magnetic Resonance (CIMAR), National High Magnetic Field Laboratory (NHMFL) , 1800 East Paul Dirac Drive, Tallahassee, Florida 32310, United States
| | - Jeffery W Kelly
- Department of Molecular and Experimental Medicine and Skaggs Institute for Chemical Biology, The Scripps Research Institute , La Jolla, California 92037, United States
| | - Michael C Fitzgerald
- Department of Chemistry, Duke University , 124 Science Drive, Durham, North Carolina 27708-0346, United States
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27
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Affiliation(s)
- Hirofumi Jono
- Department of Pharmacy, Kumamoto University Hospital, Kumamoto, Japan
- Department of Clinical Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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28
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Shamsi TN, Athar T, Parveen R, Fatima S. A review on protein misfolding, aggregation and strategies to prevent related ailments. Int J Biol Macromol 2017; 105:993-1000. [PMID: 28743576 DOI: 10.1016/j.ijbiomac.2017.07.116] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 07/13/2017] [Accepted: 07/18/2017] [Indexed: 01/28/2023]
Abstract
This review aims to highlight the fundamental mechanism of protein misfolding leading to protein aggregation and associated diseases. It also aims to anticipate novel therapeutic strategies with which to prevent or treat these highly debilitating conditions linked to these pathologies. The failure of a protein to correctly fold de novo or to remain correctly folded can have profound consequences on a living system especially when the cellular quality control processes fail to eliminate the rogue proteins. The core cause of over 20 different human diseases which have now been designated as 'conformational diseases' including neurodegenerative diseases such as Alzheimer's disease (AD), Huntington's disease (HD) and Parkinson's disease (PD) etc. A comprehensive study on protein misfolding, aggregation, and the outcomes of the effects of cytotoxic aggregates will lead to understand the aggregation-mediated cell toxicity and serves as a foundation for future research in development of promising therapies and drugs. This review has also shed light on the mechanism of protein misfolding which leads to its aggregation and hence the neurodegeneration. From these considerations, one could also envisage the possibility that protein aggregation may be exploited by nature to perform specific physiological functions in differing biological contexts.
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Affiliation(s)
- Tooba Naz Shamsi
- Department of Biotechnology, Jamia Millia Islamia, New Delhi 110025, India.
| | - Teeba Athar
- Department of Biotechnology, Jamia Millia Islamia, New Delhi 110025, India.
| | - Romana Parveen
- Department of Biotechnology, Jamia Millia Islamia, New Delhi 110025, India.
| | - Sadaf Fatima
- Department of Biotechnology, Jamia Millia Islamia, New Delhi 110025, India.
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29
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Ebenezer GJ, Liu Y, Judge DP, Cunningham K, Truelove S, Carter ND, Sebastian B, Byrnes K, Polydefkis M. Cutaneous nerve biomarkers in transthyretin familial amyloid polyneuropathy. Ann Neurol 2017; 82:44-56. [DOI: 10.1002/ana.24972] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 01/04/2023]
Affiliation(s)
| | - Ying Liu
- Department of Neurology; Johns Hopkins University
| | | | | | - Shaun Truelove
- Department of Epidemiology; Johns Hopkins Bloomberg School of Public Health; Baltimore MD
| | | | | | - Kelly Byrnes
- Department of Neurology; Johns Hopkins University
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30
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Suenaga G, Ikeda T, Masuda T, Motokawa H, Yamashita T, Takamatsu K, Misumi Y, Ueda M, Matsui H, Senju S, Ando Y. Inflammatory state exists in familial amyloid polyneuropathy that may be triggered by mutated transthyretin. Sci Rep 2017; 7:1579. [PMID: 28484271 PMCID: PMC5431548 DOI: 10.1038/s41598-017-01775-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 04/03/2017] [Indexed: 12/12/2022] Open
Abstract
The relationship between familial amyloid polyneuropathy (FAP), which is caused by mutated transthyretin (TTR), and inflammation has only recently been noted. To determine whether inflammation is present in FAP carriers and patients, serum interleukin (IL)−6 concentration in 57 healthy donors (HD), 21 FAP carriers, and 66 FAP patients was examined, with the relationship between IL-6 and TTR assessed in each group by multiple regression analysis and structural equation models (SEM). Compared with HD, IL-6 concentration was elevated in FAP carriers (p = 0.001, 95% CI 0.398–1.571) and patients (p = 0.002, 95% CI 0.362–1.521). Further, SEM indicated a positive relationship between IL-6 and TTR in FAP carriers (p = 0.010, 95% CI 0.019–0.140), but not in HD and FAP patients. In addition, we determined whether TTR induces production of pro-inflammatory cytokines ex vivo. HD-derived CD14 + monocytes and induced pluripotent stem cell-derived myeloid lineage cells from a HD and FAP patient dose-dependently produced IL-6 under mutated and aggregated TTR conditions, compared with wild-type TTR. In conclusion, FAP carriers and patients are in an inflammatory state, with the presence of mutated TTR being a trigger of inflammation, especially in FAP carriers.
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Affiliation(s)
- Genki Suenaga
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan
| | - Tokunori Ikeda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan. .,Department of Clinical Investigation, Kumamoto University, Kumamoto, Kumamoto, Japan.
| | - Teruaki Masuda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan
| | - Hiroaki Motokawa
- Department of Clinical Laboratory, National Hospital Organization Kyushu Medical Center, Fukuoka, Fukuoka, Japan
| | - Taro Yamashita
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan
| | - Kotaro Takamatsu
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan
| | - Yohei Misumi
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan
| | - Hirotaka Matsui
- Department of Molecular Laboratory Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan.,Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto, Kumamoto, Japan
| | - Satoru Senju
- Department of Immunogenetics, Kumamoto University, Kumamoto, Kumamoto, Japan
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan.
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31
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Gonçalves P, Martins H, Costelha S, Maia LF, Saraiva MJ. Efficiency of silencing RNA for removal of transthyretin V30M in a TTR leptomeningeal animal model. Amyloid 2016; 23:249-253. [PMID: 27884058 DOI: 10.1080/13506129.2016.1256282] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Some TTR mutants target the central nervous system (CNS). Familial amyloid polyneuropathy (FAP) with leptomeningeal involvement has been described in 9% of transthyretin (TTR) mutations and in valine for methionine at position 30 (V30M) patients. These individuals present dementia, ataxia, brain hemorrhages and focal neurological episodes (FNEs). FNEs occurred also in V30M FAP patients with longer disease duration, who have undergone liver transplant to remove the source of plasma mutant TTR as a form of treatment. It is thus to expect that as better treatments for FAP emerge and prolong survival, meningeal-vascular CNS deposition will increase and need special therapies. Recently, we detected TTR meningeal-vascular deposition in a V30M TTR transgenic mouse model, opening new avenues of research to investigate selective treatments of this condition. Since pre-clinical studies with TTR siRNA therapeutics were shown to promote clearance of TTR non-fibrillar deposits in several organs and tissues, we investigated its effect on TTR meningeal-vascular deposition. We show that systemically administered TTR siRNA promoted TTR clearance in the extracellular matrix of meninges and brain blood vessels. Surprisingly, despite the striking decline of blood TTR, cerebrospinal fluid TTR levels were unaffected. Though this is reassuring because siRNA will not interfere with the neuroprotective role of TTR in the CNS, it raises new questions on therapeutical approaches for CNS ATTR.
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Affiliation(s)
- Paula Gonçalves
- a Instituto de Inovação e Investigação em Saúde (I3S) and Neurobiologia Molecular - Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto , Porto , Portugal and
| | - Helena Martins
- a Instituto de Inovação e Investigação em Saúde (I3S) and Neurobiologia Molecular - Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto , Porto , Portugal and
| | - Susete Costelha
- a Instituto de Inovação e Investigação em Saúde (I3S) and Neurobiologia Molecular - Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto , Porto , Portugal and
| | - Luis F Maia
- a Instituto de Inovação e Investigação em Saúde (I3S) and Neurobiologia Molecular - Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto , Porto , Portugal and.,b Serviço de Neurologia and Unidade Corino de Andrade, Departamento de Neurociências, Hospital de Santo António, Centro Hospitalar do Porto , Porto , Portugal
| | - Maria Joao Saraiva
- a Instituto de Inovação e Investigação em Saúde (I3S) and Neurobiologia Molecular - Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto , Porto , Portugal and
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32
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The role of fibrinogen glycation in ATTR: evidence for chaperone activity loss in disease. Biochem J 2016; 473:2225-37. [DOI: 10.1042/bcj20160290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 05/12/2016] [Indexed: 12/14/2022]
Abstract
Transthyretin amyloidosis (ATTR) belongs to a class of disorders caused by protein misfolding and aggregation. ATTR is a disabling disorder of autosomal dominant trait, where transthyretin (TTR) forms amyloid deposits in different organs, causing dysfunction of the peripheral nervous system. We previously discovered that amyloid fibrils from ATTR patients are glycated by methylglyoxal. Even though no consensus has been reached about the actual role of methylglyoxal-derived advanced glycation end-products in amyloid diseases, evidence collected so far points to a role for protein glycation in conformational abnormalities, being ubiquitously found in amyloid deposits in Alzheimer's disease, dialysis-related amyloidosis and Parkinson's diseases. Human fibrinogen, an extracellular chaperone, was reported to specifically interact with a wide spectrum of stressed proteins and suppress their aggregation, being an interacting protein with TTR. Fibrinogen is differentially glycated in ATTR, leading to its chaperone activity loss. Here we show the existence of a proteostasis imbalance in ATTR linked to fibrinogen glycation by methylglyoxal.
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33
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Yokoyama T, Takaki S, Chosa K, Sato T, Suico MA, Teranishi Y, Shuto T, Mizuguchi M, Kai H. Structural stabilization of transthyretin by a new compound, 6-benzoyl-2-hydroxy-1H-benzo[de]isoquinoline-1,3(2H)-dione. J Pharmacol Sci 2015; 129:240-3. [PMID: 26639444 DOI: 10.1016/j.jphs.2015.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/14/2015] [Accepted: 09/16/2015] [Indexed: 10/22/2022] Open
Abstract
Familial amyloid polyneuropathy (FAP) is a genetic, adult-onset, neurodegenerative disorder caused by amyloid formation of transthyretin (TTR), a thyroxine-binding protein. Mutation in TTR causes a propensity of TTR tetramer to dissociate to monomer, which is the first step to amyloidosis. Thus, a drug that can stabilize the tetramer structure will have therapeutic benefit. Here, by virtual screening and biochemical assays, we identified small molecule 6-benzoyl-2-hydroxy-1H-benzo[de]isoquinoline-1,3(2H)-dione (L6) that can prevent the dissociation of TTR to monomer. X-ray crystallography reveals that L6 binds to the T4 binding pocket of TTR. These findings show that L6 is a candidate TTR stabilizer.
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Affiliation(s)
- Takeshi Yokoyama
- Faculty of Pharmaceutical Sciences, University of Toyama, Toyama 930-0914, Japan
| | - Shun Takaki
- Department of Molecular Medicine, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto 862-0973, Japan
| | - Keisuke Chosa
- Department of Molecular Medicine, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto 862-0973, Japan
| | - Takashi Sato
- Department of Analytical and Biophysical Chemistry, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto 862-0973, Japan
| | - Mary Ann Suico
- Department of Molecular Medicine, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto 862-0973, Japan
| | - Yuriko Teranishi
- Department of Molecular Medicine, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto 862-0973, Japan
| | - Tsuyoshi Shuto
- Department of Molecular Medicine, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto 862-0973, Japan
| | - Mineyuki Mizuguchi
- Faculty of Pharmaceutical Sciences, University of Toyama, Toyama 930-0914, Japan.
| | - Hirofumi Kai
- Department of Molecular Medicine, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto 862-0973, Japan.
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Novais SADL, Mendes FRP. Representation of illness in Familial Amyloidotic Polyneuropathy Portuguese Association newspaper: A documental study. Nurs Health Sci 2015; 18:85-90. [PMID: 26552610 DOI: 10.1111/nhs.12240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/06/2015] [Accepted: 07/09/2015] [Indexed: 01/02/2023]
Abstract
This study explores illness representations within Familial Amyloidotic Polyneuropathy Portuguese Association newspaper . A content analysis was performed of the issue data using provisional coding related to the conceptual framework of the study. All dimensions of illness representation in Leventhal's Common Sense Model of illness cognitions and behaviors are present in the data and reflect the experience of living with this disease. Understanding how a person living with an hereditary, rare, neurodegenerative illness is important for developing community nursing interventions. In conclusion, we suggest an integration of common sense knowledge with other approaches for designing an intervention program centered on people living with an hereditary neurodegenerative illness, such as familial amyloidotic polyneuropathy.
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Ferreira N, Pereira-Henriques A, Almeida MR. Transthyretin chemical chaperoning by flavonoids: Structure-activity insights towards the design of potent amyloidosis inhibitors. Biochem Biophys Rep 2015; 3:123-133. [PMID: 29124175 PMCID: PMC5668852 DOI: 10.1016/j.bbrep.2015.07.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/29/2015] [Accepted: 07/31/2015] [Indexed: 11/24/2022] Open
Abstract
Background Many polyphenols have been proposed as broad-spectrum inhibitors of amyloid formation. To investigate structure–activity relationships relevant for the interaction of flavonoids with transthyretin (TTR), the protein associated with familial amyloid polyneuropathy (FAP), we compared the effects of major tea catechins and their larger polymers theaflavins, side-by-side, on TTR amyloid formation process. Methods Interaction of flavonoids with TTR and effect on TTR stability were assessed through binding assays and isoelectric focusing in polyacrylamide gel. TTR aggregation was studied, in vitro, by dynamic light scattering (DLS), transmission electron microscopy (TEM) and in cell culture, through cytotoxicity assays. Results Tested flavonoids bound to TTR and stabilized the TTR tetramer, with different potencies. The flavonoids also inhibited in vitro formation of TTR small oligomeric species and in cell culture inhibited pathways involving caspase-3 activation and ER stress that are induced by TTR oligomers. In all assays performed the galloyl esters presented higher potency to inhibit aggregation than the non-gallated flavonoids tested. Conclusions Our results highlight the presence of gallate ester moiety as key structural feature of flavonoids in chemical chaperoning of TTR aggregation. Upon binding to the native tetramer, gallated flavonoids redirect the TTR amyloidogenic pathway into unstructured nontoxic aggregation assemblies more efficiently than their non-gallated forms. General significance Our findings suggest that galloyl moieties greatly enhance flavonoid anti-amyloid chaperone activity and this should be taken into consideration in therapeutic candidate drug discovery. Flavonoids are broad-spectrum inhibitors of TTR amyloid formation. The galloyl moiety is essential for chemical chaperoning of TTR by flavonoids. The galloyl moiety may be important for the design of new therapeutic agents for FAP.
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Affiliation(s)
- Nelson Ferreira
- IBMC-Instituto de Biologia Molecular e Celular, Rua do Campo Alegre 823, 4150-180 Porto, Portugal.,I3S-Instituto de Inovação e Investigação em Saúde, Universidade do Porto, Porto, Portugal
| | - Alda Pereira-Henriques
- IBMC-Instituto de Biologia Molecular e Celular, Rua do Campo Alegre 823, 4150-180 Porto, Portugal.,I3S-Instituto de Inovação e Investigação em Saúde, Universidade do Porto, Porto, Portugal
| | - Maria Rosário Almeida
- IBMC-Instituto de Biologia Molecular e Celular, Rua do Campo Alegre 823, 4150-180 Porto, Portugal.,I3S-Instituto de Inovação e Investigação em Saúde, Universidade do Porto, Porto, Portugal.,ICBAS-Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal
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Guerrini L, Arenal R, Mannini B, Chiti F, Pini R, Matteini P, Alvarez-Puebla RA. SERS Detection of Amyloid Oligomers on Metallorganic-Decorated Plasmonic Beads. ACS APPLIED MATERIALS & INTERFACES 2015; 7:9420-9428. [PMID: 25897657 DOI: 10.1021/acsami.5b01056] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Protein misfolded proteins are among the most toxic endogenous species of macromolecules. These chemical entities are responsible for neurodegenerative disorders such as Alzheimer's, Parkinson's, Creutzfeldt-Jakob's and different non-neurophatic amyloidosis. Notably, these oligomers show a combination of marked heterogeneity and low abundance in body fluids, which have prevented a reliable detection by immunological methods so far. Herein we exploit the selectivity of proteins to react with metallic ions and the sensitivity of surface-enhanced Raman spectroscopy (SERS) toward small electronic changes in coordination compounds to design and engineer a reliable optical sensor for protein misfolded oligomers. Our strategy relies on the functionalization of Au nanoparticle-decorated polystyrene beads with an effective metallorganic Raman chemoreceptor, composed by Al(3+) ions coordinated to 4-mercaptobenzoic acid (MBA) with high Raman cross-section, that selectively binds aberrant protein oligomers. The mechanical deformations of the MBA phenyl ring upon complexation with the oligomeric species are registered in its SERS spectrum and can be quantitatively correlated with the concentration of the target biomolecule. The SERS platform used here appears promising for future implementation of diagnostic tools of aberrant species associated with protein deposition diseases, including those with a strong social and economic impact, such as Alzheimer's and Parkinson's diseases.
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Affiliation(s)
- Luca Guerrini
- †Universitat Rovira i Virgili and Centro de Tecnologia Quimica de Cataluña, C/de Marcel·lí Domingo s/n, N5, 43007 Tarragona, Spain
- ‡Medcom Advance SA, Viladecans Busines Park, Edificio Brasil, C/Bertran i Musitu, 83-85, 08840 Viladecans, Barcelona, Spain
| | - Raul Arenal
- §Laboratorio de Microscopias Avanzadas (LMA), Instituto de Nanociencia de Aragon (INA), Universidad de Zaragoza, 50018 Zaragoza, Spain
- ∥Fundación ARAID, 50018 Zaragoza, Spain
| | - Benedetta Mannini
- ⊥Department of Biomedical Experimental and Clinical Sciences, University of Florence, 50134 Florence, Italy
| | - Fabrizio Chiti
- ⊥Department of Biomedical Experimental and Clinical Sciences, University of Florence, 50134 Florence, Italy
| | - Roberto Pini
- #Institute of Applied Physics Nello Carrara, National Research Council, via Madonna del Piano 10, 50019 Sesto Fiorentino, Italy
| | - Paolo Matteini
- #Institute of Applied Physics Nello Carrara, National Research Council, via Madonna del Piano 10, 50019 Sesto Fiorentino, Italy
| | - Ramon A Alvarez-Puebla
- †Universitat Rovira i Virgili and Centro de Tecnologia Quimica de Cataluña, C/de Marcel·lí Domingo s/n, N5, 43007 Tarragona, Spain
- ‡Medcom Advance SA, Viladecans Busines Park, Edificio Brasil, C/Bertran i Musitu, 83-85, 08840 Viladecans, Barcelona, Spain
- ○ICREA, Passeig Lluís Companys 23, 08010 Barcelona, Spain
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Alshehri B, D'Souza DG, Lee JY, Petratos S, Richardson SJ. The diversity of mechanisms influenced by transthyretin in neurobiology: development, disease and endocrine disruption. J Neuroendocrinol 2015; 27:303-23. [PMID: 25737004 DOI: 10.1111/jne.12271] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 02/23/2015] [Accepted: 02/24/2015] [Indexed: 12/12/2022]
Abstract
Transthyretin (TTR) is a protein that binds and distributes thyroid hormones (THs). TTR synthesised in the liver is secreted into the bloodstream and distributes THs around the body, whereas TTR synthesised in the choroid plexus is involved in movement of thyroxine from the blood into the cerebrospinal fluid and the distribution of THs in the brain. This is important because an adequate amount of TH is required for normal development of the brain. Nevertheless, there has been heated debate on the role of TTR synthesised by the choroid plexus during the past 20 years. We present both sides of the debate and how they can be reconciled by the discovery of TH transporters. New roles for TTR have been suggested, including the promotion of neuroregeneration, protection against neurodegeneration, and involvement in schizophrenia, behaviour, memory and learning. Recently, TTR synthesis was revealed in neurones and peripheral Schwann cells. Thus, the synthesis of TTR in the central nervous system (CNS) is more extensive than previously considered and bolsters the hypothesis that TTR may play wide roles in neurobiological function. Given the high conservation of TTR structure, function and tissue specificity and timing of gene expression, this implies that TTR has a fundamental role, during development and in the adult, across vertebrates. An alarming number of 'unnatural' chemicals can bind to TTR, thus potentially interfering with its functions in the brain. One role of TTR is delivery of THs throughout the CNS. Reduced TH availability during brain development results in a reduced IQ. The combination of the newly discovered sites of TTR synthesis in the CNS, the increasing number of neurological diseases being associated with TTR, the newly discovered functions of TTR and the awareness of the chemicals that can interfere with TTR biology render this a timely review on TTR in neurobiology.
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Affiliation(s)
- B Alshehri
- School of Medical Sciences, RMIT University, Bundoora, VIC, Australia
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Wixner J, Sundström T, Karling P, Anan I, Suhr OB. Outcome of gastric emptying and gastrointestinal symptoms after liver transplantation for hereditary transthyretin amyloidosis. BMC Gastroenterol 2015; 15:51. [PMID: 25908211 PMCID: PMC4415350 DOI: 10.1186/s12876-015-0284-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 04/17/2015] [Indexed: 01/03/2023] Open
Abstract
Background Hereditary transthyretin amyloid (ATTR) amyloidosis is a rare but fatal autosomal dominant condition that is present all over the world. A liver transplantation has been shown to halt the progress of the disease in selected patients and is currently considered to be the standard treatment. Gastrointestinal manifestations are common in hereditary ATTR amyloidosis and are important for the patients’ morbidity and mortality. The aim of this study was to evaluate the long-term outcome of gastric emptying, gastrointestinal symptoms and nutritional status after liver transplantation for the disease. Methods Swedish patients with hereditary ATTR amyloidosis transplanted between 1990 and 2012 were included. A standardized method for measuring gastric emptying with a Tc99m-labelled meal followed by scintigraphy was utilized. Validated questionnaires were used to assess gastrointestinal symptoms and the modified body mass index (mBMI), in which BMI is multiplied by s-albumin, was used to evaluate nutritional status. Non-parametrical statistical tests were used. Results Gastric emptying rates and nutritional statuses were evaluated approximately eight months before and two and five years after liver transplantation, whereas gastrointestinal symptoms were assessed in median nine months before and two and nine years after transplantation. No significant change was found in gastric emptying (median half-time 137 vs. 132 vs. 125 min, p = 0.52) or nutritional status (median mBMI 975 vs. 991 vs. 973, p = 0.75) after transplantation. Gastrointestinal symptom scores, however, had increased significantly over time (median score 7 vs. 10 vs. 13, p < 0.01). Conclusions Gastric emptying and nutritional status were maintained after liver transplantation for hereditary ATTR amyloidosis, although gastrointestinal symptom scores had increased over time. Electronic supplementary material The online version of this article (doi:10.1186/s12876-015-0284-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jonas Wixner
- Departments of Public Health and Clinical Medicine, Umeå University, S-90187, Umeå, Sweden.
| | | | - Pontus Karling
- Departments of Public Health and Clinical Medicine, Umeå University, S-90187, Umeå, Sweden.
| | - Intissar Anan
- Departments of Public Health and Clinical Medicine, Umeå University, S-90187, Umeå, Sweden.
| | - Ole B Suhr
- Departments of Public Health and Clinical Medicine, Umeå University, S-90187, Umeå, Sweden.
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Murakami T, Sango K, Watabe K, Niimi N, Takaku S, Li Z, Yamamura KI, Sunada Y. Schwann cells contribute to neurodegeneration in transthyretin amyloidosis. J Neurochem 2015; 134:66-74. [DOI: 10.1111/jnc.13068] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 01/30/2015] [Accepted: 02/03/2015] [Indexed: 12/15/2022]
Affiliation(s)
| | - Kazunori Sango
- Department of Sensory and Motor Systems (ALS/Neuropathy Project); Tokyo Metropolitan Institute of Medical Science; Tokyo Japan
| | - Kazuhiko Watabe
- Department of Sensory and Motor Systems (ALS/Neuropathy Project); Tokyo Metropolitan Institute of Medical Science; Tokyo Japan
| | - Naoko Niimi
- Department of Sensory and Motor Systems (ALS/Neuropathy Project); Tokyo Metropolitan Institute of Medical Science; Tokyo Japan
| | - Shizuka Takaku
- Department of Sensory and Motor Systems (ALS/Neuropathy Project); Tokyo Metropolitan Institute of Medical Science; Tokyo Japan
| | - Zhenghua Li
- Division of Developmental Genetics; Institute of Resource Development and Analysis; Kumamoto University; Kumamoto Japan
| | - Ken-ichi Yamamura
- Division of Developmental Genetics; Institute of Resource Development and Analysis; Kumamoto University; Kumamoto Japan
| | - Yoshihide Sunada
- Department of Neurology; Kawasaki Medical School; Kurashiki Japan
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Dohrn MF, Othman A, Hirshman SK, Bode H, Alecu I, Fähndrich E, Karges W, Weis J, Schulz JB, Hornemann T, Claeys KG. Elevation of plasma 1-deoxy-sphingolipids in type 2 diabetes mellitus: a susceptibility to neuropathy? Eur J Neurol 2015; 22:806-14, e55. [DOI: 10.1111/ene.12663] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 11/28/2014] [Indexed: 12/31/2022]
Affiliation(s)
- M. F. Dohrn
- Department of Neurology; RWTH Aachen University; Aachen Germany
- Institute of Neuropathology; RWTH Aachen University; Aachen Germany
| | - A. Othman
- Institute of Clinical Chemistry; University Hospital Zürich; Zürich Switzerland
- Centre for Integrative Human Physiology; University of Zürich; Zürich Switzerland
| | - S. K. Hirshman
- Department of Neurology; RWTH Aachen University; Aachen Germany
| | - H. Bode
- Institute of Clinical Chemistry; University Hospital Zürich; Zürich Switzerland
- Centre for Integrative Human Physiology; University of Zürich; Zürich Switzerland
| | - I. Alecu
- Institute of Clinical Chemistry; University Hospital Zürich; Zürich Switzerland
- Centre for Integrative Human Physiology; University of Zürich; Zürich Switzerland
| | - E. Fähndrich
- Division of Endocrinology and Diabetes; RWTH Aachen University; Aachen Germany
| | - W. Karges
- Division of Endocrinology and Diabetes; RWTH Aachen University; Aachen Germany
| | - J. Weis
- Institute of Neuropathology; RWTH Aachen University; Aachen Germany
- JARA - Translational Brain Medicine; Aachen Germany
| | - J. B. Schulz
- Department of Neurology; RWTH Aachen University; Aachen Germany
- JARA - Translational Brain Medicine; Aachen Germany
| | - T. Hornemann
- Institute of Clinical Chemistry; University Hospital Zürich; Zürich Switzerland
- Centre for Integrative Human Physiology; University of Zürich; Zürich Switzerland
| | - K. G. Claeys
- Department of Neurology; RWTH Aachen University; Aachen Germany
- Institute of Neuropathology; RWTH Aachen University; Aachen Germany
- JARA - Translational Brain Medicine; Aachen Germany
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Kollmer J, Hund E, Hornung B, Hegenbart U, Schönland SO, Kimmich C, Kristen AV, Purrucker J, Röcken C, Heiland S, Bendszus M, Pham M. In vivo detection of nerve injury in familial amyloid polyneuropathy by magnetic resonance neurography. ACTA ACUST UNITED AC 2014; 138:549-62. [PMID: 25526974 PMCID: PMC4339768 DOI: 10.1093/brain/awu344] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
See Morrow and Reilly (doi:10.1093/awu396) for a scientific commentary on this article. Transthyretin familial amyloid polyneuropathy is a rare, autosomal-dominant multisystem disorder. Kollmer et al. show that high-resolution MR-neurography can quantify and localize lower limb nerve injury in vivo, both in symptomatic patients and in asymptomatic mutation carriers. Lesions appear at thigh-level and are predominantly proximal, although symptoms start and prevail distally. Transthyretin familial amyloid polyneuropathy is a rare, autosomal-dominant inherited multisystem disorder usually manifesting with a rapidly progressive, axonal, distally-symmetric polyneuropathy. The detection of nerve injury by nerve conduction studies is limited, due to preferential involvement of small-fibres in early stages. We investigated whether lower limb nerve-injury can be detected, localized and quantified in vivo by high-resolution magnetic resonance neurography. We prospectively included 20 patients (12 male and eight female patients, mean age 47.9 years, range 26–66) with confirmed mutation in the transthyretin gene: 13 with symptomatic polyneuropathy and seven asymptomatic gene carriers. A large age- and sex-matched cohort of healthy volunteers served as controls (20 male and 20 female, mean age 48.1 years, range 30–73). All patients received detailed neurological and electrophysiological examinations and were scored using the Neuropathy Impairment Score–Lower Limbs, Neuropathy Deficit and Neuropathy Symptom Score. Magnetic resonance neurography (3 T) was performed with large longitudinal coverage from proximal thigh to ankle-level and separately for each leg (140 axial slices/leg) by using axial T2-weighted (repetition time/echo time = 5970/55 ms) and dual echo (repetition time 5210 ms, echo times 12 and 73 ms) turbo spin echo 2D sequences with spectral fat saturation. A 3D T2-weighted inversion-recovery sequence (repetition time/echo time 3000/202 ms) was acquired for imaging of the spinal nerves and lumbar plexus (50 axial slice reformations). Precise manual segmentation of the spinal/sciatic/tibial/common peroneal nerves was performed on each slice. Histogram-based normalization of nerve–voxel signal intensities was performed using the age- and sex-matched control group as normative reference. Nerve-voxels were subsequently classified as lesion-voxels if a threshold of >1.2 (normalized signal-intensity) was exceeded. At distal thigh level, where a predominant nerve–lesion–voxel burden was observed, signal quantification was performed by calculating proton spin density and T2-relaxation time as microstructural markers of nerve tissue integrity. The total number of nerve–lesion voxels (cumulated from proximal-to-distal) was significantly higher in symptomatic patients (20 405 ± 1586) versus asymptomatic gene carriers (12 294 ± 3199; P = 0.036) and versus controls (6536 ± 467; P < 0.0001). It was also higher in asymptomatic carriers compared to controls (P = 0.043). The number of nerve–lesion voxels was significantly higher at thigh level compared to more distal levels (lower leg/ankle) of the lower extremities (f-value = 279.22, P < 0.0001). Further signal-quantification at this proximal site (thigh level) revealed a significant increase of proton-density (P < 0.0001) and T2-relaxation-time (P = 0.0011) in symptomatic patients, whereas asymptomatic gene-carriers presented with a significant increase of proton-density only. Lower limb nerve injury could be detected and quantified in vivo on microstructural level by magnetic resonance neurography in symptomatic familial amyloid polyneuropathy, and also in yet asymptomatic gene carriers, in whom imaging detection precedes clinical and electrophysiological manifestation. Although symptoms start and prevail distally, the focus of predominant nerve injury and injury progression was found proximally at thigh level with strong and unambiguous lesion-contrast. Imaging of proximal nerve lesions, which are difficult to detect by nerve conduction studies, may have future implications also for other distally-symmetric polyneuropathies.
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Affiliation(s)
- Jennifer Kollmer
- 1 Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany 2 Amyloidosis Centre Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Ernst Hund
- 2 Amyloidosis Centre Heidelberg, University of Heidelberg, Heidelberg, Germany 3 Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Benjamin Hornung
- 1 Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Ute Hegenbart
- 2 Amyloidosis Centre Heidelberg, University of Heidelberg, Heidelberg, Germany 4 Medical Department V, University of Heidelberg, Heidelberg, Germany
| | - Stefan O Schönland
- 2 Amyloidosis Centre Heidelberg, University of Heidelberg, Heidelberg, Germany 4 Medical Department V, University of Heidelberg, Heidelberg, Germany
| | - Christoph Kimmich
- 2 Amyloidosis Centre Heidelberg, University of Heidelberg, Heidelberg, Germany 4 Medical Department V, University of Heidelberg, Heidelberg, Germany
| | - Arnt V Kristen
- 2 Amyloidosis Centre Heidelberg, University of Heidelberg, Heidelberg, Germany 5 Medical Department III, University of Heidelberg, Heidelberg, Germany
| | - Jan Purrucker
- 2 Amyloidosis Centre Heidelberg, University of Heidelberg, Heidelberg, Germany 3 Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Christoph Röcken
- 6 Department of Pathology, University Hospital Kiel, Kiel, Germany
| | - Sabine Heiland
- 1 Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany 7 Division of Experimental Radiology, Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Martin Bendszus
- 1 Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Mirko Pham
- 1 Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany 2 Amyloidosis Centre Heidelberg, University of Heidelberg, Heidelberg, Germany
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Gonçalves NP, Costelha S, Saraiva MJ. Glial cells in familial amyloidotic polyneuropathy. Acta Neuropathol Commun 2014; 2:177. [PMID: 25519307 PMCID: PMC4280682 DOI: 10.1186/s40478-014-0177-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 12/08/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Transthyretin V30M mutation is the most common variant leading to Familial Amyloidotic Polyneuropathy. In this genetic disorder, Transthyretin accumulates preferentially in the extracellular matrix of peripheral and autonomic nervous systems leading to cell death and dysfunction. Thus, knowledge regarding important biological systems for Transthyretin clearance might unravel novel insights into Familial Amyloidotic Polyneuropathy pathophysiology. Herein, our aim was to evaluate the ability of glial cells from peripheral and autonomic nervous systems in Transthyretin uptake and degradation. We assessed the role of glial cells in Familial Amyloidotic Polyneuropathy pathogenesis with real-time polymerase chain reaction, immunohistochemistry, interference RNA and confocal microscopy. RESULTS Histological examination revealed that Schwann cells and satellite cells, from an Familial Amyloidotic Polyneuropathy mouse model, internalize and degrade non-fibrillar Transthyretin. Immunohistochemical studies of human nerve biopsies from V30M patients and disease controls showed intracellular Transthyretin immunoreactivity in Schwann cells, corroborating animal data. Additionally, we found Transthyretin expression in colon of this Familial Amyloidotic Polyneuropathy mouse model, probably being synthesized by satellite cells of the myenteric plexus. CONCLUSIONS Glial cells from the peripheral and autonomic nervous systems are able to internalize Transthyretin. Overall, these findings bring to light the closest relationship between Transthyretin burden and clearance from the nervous system extracellular milieu.
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Gonçalves NP, Teixeira-Coelho M, Saraiva MJ. The inflammatory response to sciatic nerve injury in a familial amyloidotic polyneuropathy mouse model. Exp Neurol 2014; 257:76-87. [DOI: 10.1016/j.expneurol.2014.04.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 04/03/2014] [Accepted: 04/28/2014] [Indexed: 11/29/2022]
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Gasperini RJ, Klaver DW, Hou X, Aguilar MI, Small DH. Mechanisms of transthyretin aggregation and toxicity. Subcell Biochem 2014; 65:211-24. [PMID: 23225005 DOI: 10.1007/978-94-007-5416-4_9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Amyloidoses are characterised by the deposition of insoluble protein that occurs in the extracellular compartment of various tissues. One form of amyloidosis is caused by transthyretin (TTR) misfolding and deposition in target tissues. It is clear that many amyloidoses share common features of fibrillogenesis and toxicity. This chapter examines the mechanisms of TTR aggregation with a view to understanding the possible therapeutic interventions in amyloid disease.
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Affiliation(s)
- Robert J Gasperini
- Menzies Research Institute, University of Tasmania, Liverpool Street, 7001, Hobart, TAS, Australia,
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Pro-oxidative effects of aggregated transthyretin in human Schwannoma cells. Neurotoxicology 2013; 39:109-13. [DOI: 10.1016/j.neuro.2013.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 08/01/2013] [Accepted: 08/13/2013] [Indexed: 01/21/2023]
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Juranek JK, Kothary P, Mehra A, Hays A, Brannagan TH, Schmidt AM. Increased expression of the receptor for advanced glycation end-products in human peripheral neuropathies. Brain Behav 2013; 3:701-9. [PMID: 24363972 PMCID: PMC3868174 DOI: 10.1002/brb3.176] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 08/07/2013] [Accepted: 08/08/2013] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Diabetic neuropathy and idiopathic neuropathy are among the most prevalent neuropathies in human patients. The molecular mechanism underlying pathological changes observed in the affected nerve remains unclear but one candidate molecule, the receptor for advanced glycation end-products (RAGE), has recently gained attention as a potential contributor to neuropathy. Our previous studies revealed that RAGE expression is higher in porcine and murine diabetic nerve, contributing to the inflammatory mechanisms leading to diabetic neuropathy. Here, for the first time, we focused on the expression of RAGE in human peripheral nerve. METHODS Our study utilized de-identified human sural nerve surplus obtained from 5 non-neuropathic patients (control group), 6 patients with long-term mild-to-moderate diabetic neuropathy (diabetic group) and 5 patients with mild-to-moderate peripheral neuropathy of unknown etiology (idiopathic group). By using immunofluorescent staining and protein immunoblotting we studied the expression and colocalization patterns of RAGE and its ligands: carboxymethyllysine (CML), high mobility group box 1 (HMBG1) and mammalian Diaphanous 1 (mDia1) in control and neuropathic nerves. RESULTS We found that in a normal, healthy human nerve, RAGE is expressed in almost 30% of all nerve fibers and that number is higher in pathological states such as peripheral neuropathy. We established that the levels of RAGE and its pro-inflammatory ligands, CML and HMBG1, are higher in both idiopathic and diabetic nerve, while the expression of the RAGE cytoplasmic domain-binding partner, mDia1 is similar among control, diabetic, and idiopathic nerve. The highest number of double stained nerve fibers was noted for RAGE and CML: ∼76% (control), ∼91% (idiopathic) and ∼82% (diabetic) respectively. CONCLUSIONS Our data suggest roles for RAGE and its inflammatory ligands in human peripheral neuropathies and lay the foundation for further, more detailed and clinically oriented investigation involving these proteins and their roles in disorders of the human peripheral nerve.
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Affiliation(s)
- Judyta K Juranek
- Department of Surgery, Columbia University Medical Center New York, New York ; Diabetes Research Program, Department of Medicine, NYU Medical Center New York, New York
| | - Pratik Kothary
- Department of Surgery, Columbia University Medical Center New York, New York ; Diabetes Research Program, Department of Medicine, NYU Medical Center New York, New York
| | - Alka Mehra
- Infectious Diseases Center, Department of Medicine, NYU Medical Center New York, New York
| | - Arthur Hays
- Department of Pathology, Columbia University Medical Center New York, New York
| | - Thomas H Brannagan
- Department of Neurology, Columbia University Medical Center New York, New York
| | - Ann Marie Schmidt
- Department of Surgery, Columbia University Medical Center New York, New York ; Diabetes Research Program, Department of Medicine, NYU Medical Center New York, New York
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Dohrn MF, Röcken C, De Bleecker JL, Martin JJ, Vorgerd M, Van den Bergh PY, Ferbert A, Hinderhofer K, Schröder JM, Weis J, Schulz JB, Claeys KG. Diagnostic hallmarks and pitfalls in late-onset progressive transthyretin-related amyloid-neuropathy. J Neurol 2013; 260:3093-108. [PMID: 24101130 DOI: 10.1007/s00415-013-7124-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 09/17/2013] [Accepted: 09/17/2013] [Indexed: 01/29/2023]
Abstract
Familial amyloid polyneuropathy (FAP) is a progressive systemic autosomal dominant disease caused by pathogenic mutations in the transthyretin (TTR) gene. We studied clinical, electrophysiological, histopathological, and genetic characteristics in 15 (13 late-onset and two early-onset) patients belonging to 14 families with polyneuropathy and mutations in TTR. In comparison, we analysed the features of nine unrelated patients with an idiopathic polyneuropathy, in whom TTR mutations have been excluded. Disease occurrence was familial in 36 % of the patients with TTR-associated polyneuropathy and the late-onset type was observed in 86 % (mean age at onset 65.5 years). Clinically, all late-onset TTR-mutant patients presented with distal weakness, pansensory loss, absence of deep tendon reflexes, and sensorimotor hand involvement. Afferent-ataxic gait was present in 92 % leading to wheelchair dependence in 60 % after a mean duration of 4.6 years. Autonomic involvement was observed in 60 %, and ankle edema in 92 %. The sensorimotor polyneuropathy was from an axonal type in 82 %, demyelinating or mixed type in 9 % each. Compared to the TTR-unmutated idiopathic polyneuropathy patients, we identified rapid progression, early ambulatory loss, and autonomic disturbances, associated with a severe polyneuropathy as red flags for TTR-FAP. In 18 % of the late-onset TTR-FAP patients, no amyloid was found in nerve biopsies. Further diagnostic pitfalls were unspecific electrophysiology, and coincident diabetes mellitus (23 %) or monoclonal gammopathy (7 %). We conclude that a rapid disease course, severely ataxic gait, hand involvement, and autonomic dysfunction are diagnostic hallmarks of late-onset TTR-FAP. Genetic analysis should be performed even when amyloid deposits are lacking or when polyneuropathy-causing comorbidities are concomitant.
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Affiliation(s)
- Maike F Dohrn
- Department of Neurology, RWTH Aachen University, Aachen, Germany
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Wixner J, Obayashi K, Ando Y, Karling P, Anan I. Loss of gastric interstitial cells of Cajal in patients with hereditary transthyretin amyloidosis. Amyloid 2013; 20:99-106. [PMID: 23642163 PMCID: PMC3682206 DOI: 10.3109/13506129.2013.787985] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hereditary transthyretin (TTR) amyloidosis is a systemic neuropathic disorder caused by TTR gene mutations. Gastrointestinal complications are common and the underlying mechanisms remain unclear. The interstitial cells of Cajal (ICC) function as pacemaker cells in the gastrointestinal tract and are important for gastrointestinal motility. The aim of this study was to investigate the densities of gastric ICC and nerves in patients with TTR amyloidosis compared to non-amyloidosis controls. METHODS Antral wall autopsy specimens from 11 Japanese ATTR V30M patients and 10 controls were analyzed with immunohistochemistry and computerized analysis. Antibodies to c-Kit and TMEM16A were used to assess ICC and an antibody to PGP 9.5 was used to assess nervous tissue. The study was approved by a Japanese ethical committee. RESULTS The densities of c-Kit-immunoreactive (IR) ICC were significantly lower in the circular and longitudinal muscle layers of patients compared to controls (p = 0.004 for both). Equivalent results were found for TMEM16A-IR ICC. There were no significant differences in PGP 9.5-IR cells in the circular or longitudinal muscle layers between patients and controls (p = 0.173 and 0.099, respectively). CONCLUSIONS A loss of gastrointestinal ICC may be an important factor for the digestive disturbances in hereditary TTR amyloidosis.
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Affiliation(s)
- Jonas Wixner
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
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Amaral da Silva Souza MV, Santos Soares CC, Rega de Oliveira J, Rosa de Oliveira C, Hargreaves Fialho P, Cunha DM, Cunha DM, Kopiler DA, Rangel Tura B, Batista da Cunha A. Heart rate variability: Analysis of time-domain indices in patients with chronic Chagas disease before and after an exercise program. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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[Heart rate variability: analysis of time-domain indices in patients with chronic Chagas disease before and after an exercise program]. Rev Port Cardiol 2013; 32:219-27. [PMID: 23499156 DOI: 10.1016/j.repc.2012.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 10/11/2012] [Indexed: 11/21/2022] Open
Abstract
UNLABELLED Chagas disease (CD) is an infection caused by the protozoan flagellate Trypanosoma cruzi, and transmitted by insects of the genera Triatoma, Rhodnius and Panstrongylus. The heart is affected to varying degrees by inflammatory and destructive lesions in atrial and ventricular myocardial fibers. Several studies have demonstrated the benefits of exercise in patients with congestive heart failure (CHF), including reduced sympathetic tone and increased parasympathetic tone, the result of reduced epinephrine and norepinephrine levels, both at rest and during exercise, including at submaximal levels. It has been hypothesized that the increase in sympathetic arousal during exercise improves peripheral muscle metabolism. OBJECTIVES The objectives of this study were to select patients with chronic Chagas cardiomyopathy (CCC) with dysautonomia on 24-h Holter monitoring, assess autonomic function after rehabilitation, and determine whether it resulted in reduced daytime levels of SDNN and increased daytime and nighttime levels of pNN50 and rMSSD. METHODS We analyzed time-domain indices of heart rate variability through 24-h Holter monitoring before and after a supervised exercise program. We studied 18 CCC patients (five men), mean age 57.33±9.73 years, followed at the CD outpatient clinic of the National Institute of Cardiology and IPEC/Fiocruz in Rio de Janeiro, Brazil, between April 2009 and November 2010. The following tests were used to assess the severity of CCC: clinical examination, functional evaluation by cardiopulmonary stress testing, electrocardiogram and conventional Doppler echocardiography. The exams were performed within a month of the start and end of the exercise program, which consisted of 60-min sessions of aerobic exercise on a treadmill and resistance training three times a week for six months. The goal was to reach the patients' heart rate target zone during training, and their rating of perceived exertion was assessed by the modified Borg scale. RESULTS There were no statistically significant differences (p>0.05) in SDNN, pNN50 and rMSSD, probably due to the large standard deviation observed, patients' poor adherence to the program and their low socioeconomic status, resulting in a small sample, and the short duration of the program. CONCLUSION Heart rate variability parameters in patients with CCC did not undergo statistically significant changes after a six-month cardiac rehabilitation program.
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