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Chacko L, Martinez-Naharro A, Kotecha T, Martone R, Hutt D, Lane T, Knight D, Moon J, Kellman P, Hawkins P, Gillmore J, Fontana M. Regression of cardiac amyloid deposits with novel therapeutics: reaching new frontiers in cardiac ATTR amyloidosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Cardiac involvement is the main driver of outcome in ATTR amyloidosis. Advances in therapeutics hold potential in transforming the course of the disease but the impact on cardiac amyloid load is unknown. The aim of this study was to evaluate the impact of patisiran, a new double stranded RNA based gene silencing therapy and a stabilizer, diflunisal, on cardiac amyloid load as measured by CMR and T1 mapping, in patients with ATTR amyloidosis.
Methods and results
Thirty-two patients with hereditary cardiac amyloidosis were studied. Sixteen patients received treatment with patisiran, and sixteen control subjects did not receive any disease modifying treatment. Patients were assessed with echocardiogram, CMR, NT-proBNP and six-minute walk time measurements at baseline and at 1 year (Mean interval 11.45±3.08 months in treatment group, mean interval 12.82±5.06 months in the control group). CMR analysis comprised LV volumes, T1 mapping to measure the extracellular volume (ECV) occupied by amyloid, T2 mapping and late gadolinium enhancement imaging. At 1-year follow-up, there was a substantial reduction in cardiac amyloid burden, in keeping with cardiac amyloid regression in 45% of patients on treatment. Overall the treatment group showed a reduction in ECV at 1 year follow up compared to an increase in ECV at 1 year in the control group (−1.37%, 95% CI: −3.43 to 0.68% versus 5.02%, 95% CI: 2.86% to 7.18% respectively, p<0.001). The treatment group also showed an improvement in change in 6MWT at 1 year follow up compared to 6MWT at 1 year in the control group (−8.12 meters, 95% CI: −50.8 to 34.6 meters in the treatment group versus −132.27 meters, 95% CI: −216 to −48.6 meters in the control group, p=0.002). The treatment group showed a reduction in BNP at 1 year follow up compared to an increase in the control group (−567.87, 95% CI: −1288.90 to 153.15 in the treatment group versus 2004, 95% CI: 12.82 to 3995.45 in the control group, p<0.001). There was no significant difference from baseline and 1-year data between the control and treatment groups for the difference in echocardiographic parameters, native T1, T2. There was a significant reduction in the percentage of injected dose by 99Tc-DPD scintigraphy in treated patients at 1 year compared to baseline.
Conclusions
These findings provide the first compelling evidence of substantial cardiac amyloid regression in ATTR amyloidosis, as well as the potential for CMR to be used to track response in treated patients with ATTR cardiac amyloidosis. Combination therapy with transthyretin knock down and stabilizing agents may well be synergistic given enhanced stoichiometry of stabilizers in the face of much reduced plasma transthyretin concentration.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- L Chacko
- University College Hospital, London, United Kingdom
| | | | - T Kotecha
- University College Hospital, London, United Kingdom
| | - R Martone
- Careggi University Hospital, Florence, Italy
| | - D Hutt
- University College Hospital, London, United Kingdom
| | - T Lane
- University College Hospital, London, United Kingdom
| | - D Knight
- University College Hospital, London, United Kingdom
| | - J Moon
- Barts Heart Centre, London, United Kingdom
| | - P Kellman
- National Institutes of Health, Bethesda, United States of America
| | - P Hawkins
- University College Hospital, London, United Kingdom
| | - J Gillmore
- University College Hospital, London, United Kingdom
| | - M Fontana
- University College Hospital, London, United Kingdom
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Abstract
BACKGROUND Metacarpal shaft fractures that necessitate surgery are frequently fixated with either intramedullary pins or plates and screws. This study compared outcome measurements of these two techniques. METHODS Patients operated on for closed shaft fractures of metacarpals 2-5 were examined at least 1 year after injury. All fractures were fixated by pinning between years 2013 and 2015 and by locking plates and screws between 2016 and 2017. Evaluation included range of motion measurements for all fingers compared with the contralateral hand; comparison of grip strength; finger alignment and rotation; Disabilities of the Arm, Shoulder and Hand (DASH) score; and radiographic measurements of fracture reduction and healing. RESULTS Thirty patients with 39 fractured metacarpals treated by pinning were compared with 29 patients with 35 fractured metacarpals treated by locking plate and screws. Both groups had similar characteristics and preoperative fracture patterns on radiograph. Patients in the plate group were found to have significantly improved outcomes in total range of motion of the operated digits (loss of 4° extension, 10° flexion, and 14° total vs 10° extension, 19° flexion, and 29° total), grip strength (93% vs 83% of contralateral hand), rotational deformity (5 digits, 1° vs 15 digits, 6°), and DASH score (10.5 vs 15.6). Radiographic bone healing time (59 vs 50 days) and operative time (58 vs 41 minutes) were both significantly longer in fractures fixated by plates. CONCLUSIONS Fixation with locking plates allows earlier mobilization without need for splinting. Our study supports the use of this method over intramedullary pinning for metacarpal shaft fractures.
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Affiliation(s)
- Daniel Dreyfuss
- Rambam Health Care Campus, Haifa, Israel,Daniel Dreyfuss, Hand and Microsurgery Unit, Rambam Health Care Campus, 8 Haaliya Hashniya Street, Haifa 3525408, Israel.
| | - Raviv Allon
- Technion–Israel Institute of Technology, Haifa, Israel
| | - Nufar Izacson
- Technion–Israel Institute of Technology, Haifa, Israel
| | - Dan Hutt
- Rambam Health Care Campus, Haifa, Israel
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Otremski H, Dolkart O, Atlan F, Hutt D, Segev E, Pritsch T, Rosenblatt Y. Hairline fractures following volar plating of the distal radius: a recently recognized hardware-related complication. Skeletal Radiol 2018; 47:833-837. [PMID: 29356843 DOI: 10.1007/s00256-018-2877-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/26/2017] [Accepted: 01/02/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Intraoperative hairline longitudinal fractures were recently reported in association with distal radius volar plating. Our aim was to further analyze this newly described complication. METHODS A retrospective radiographic and chart review was performed on 225 patients who underwent distal radius plating between June 2013 and June 2015. The Acu-Loc/Acu-Loc2© plating system (Acumed, Hillsboro, OR, USA) was used in 208 cases, and the VariAx© plating system (Stryker, Kalamazoo, MI, USA) was used in 17 cases. Three independent reviewers performed a blind evaluation of all relevant radiographs for the occurrence of longitudinal fractures around the plate, and validity was considered only when there was agreement among all three of them. RESULTS Hairline longitudinal fractures were identified in 57 cases (25%), 55 with the Acu-Loc/Acu-Loc2© system and 2 with the VariAx© system. All fractures occurred with volar plating. Fracture occurrence was associated with age over 59 years, female gender, extra-articular fractures, and the use of Hexalobe screws (Acu-Loc/Acu-Loc2© system). CONCLUSIONS We believe that the source of fracture occurrence lies within the screw design and that better screw design and possibly tapping in patients at risk may reduce the occurrence of intraoperative hairline longitudinal fractures. Further clinical and biomechanical research is needed to better understand this newly reported complication.
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Affiliation(s)
- Hila Otremski
- Hand Surgery Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oleg Dolkart
- Hand Surgery Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Franck Atlan
- Hand Surgery Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Hutt
- Hand Surgery Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Segev
- Faculty of Science, Holon Institute of Technology, Holon, Israel
| | - Tamir Pritsch
- Hand Surgery Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yishai Rosenblatt
- Hand Surgery Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Hutt D, Nehari M, Munitz-Shenkar D, Alkalay Y, Toren A, Bielorai B. Hematopoietic stem cell donation: psychological perspectives of pediatric sibling donors and their parents. Bone Marrow Transplant 2015; 50:1337-42. [DOI: 10.1038/bmt.2015.152] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/30/2015] [Accepted: 05/14/2015] [Indexed: 12/14/2022]
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Carr AS, Pelayo-Negro AL, Jaunmuktane Z, Scalco RS, Hutt D, Evans MRB, Heally E, Brandner S, Holton J, Blake J, Whelan CJ, Wechalekar AD, Gillmore JD, Hawkins PN, Reilly MM. Transthyretin V122I amyloidosis with clinical and histological evidence of amyloid neuropathy and myopathy. Neuromuscul Disord 2015; 25:511-5. [PMID: 25819286 DOI: 10.1016/j.nmd.2015.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 01/23/2015] [Accepted: 02/09/2015] [Indexed: 12/31/2022]
Abstract
Hereditary transthyretin amyloidosis (ATTR) is a genetically and clinically heterogeneous disease manifesting with predominant peripheral and autonomic neuropathy; cardiomyopathy, or both. ATTR V122I is the most common variant associated with non-neuropathic familial amyloid cardiomyopathy. We present an unusual case of V122I amyloidosis with features of amyloid neuropathy and myopathy, supported by histological confirmation in both sites and diffuse tracer uptake on (99m)Tc-3,3-Diphosphono-1,2-Propanodicarboxylic acid (DPD) scintigraphy throughout skeletal and cardiac muscle. A 64 year old Jamaican man presented with cardiac failure. Cardiac MR revealed infiltrative cardiomyopathy; abdominal fat aspirate confirmed the presence of amyloid, and he was homozygous for the V122I variant of transthyretin. He also described general weakness and EMG demonstrated myopathic features. Sural nerve and vastus lateralis biopsy showed TTR amyloid. The patient is being treated with diflunisal, an oral TTR stabilising agent. Symptomatic myopathy and neuropathy with confirmation of tissue amyloid deposition has not previously been described. Extracardiac amyloidosis has implications for diagnosis and treatment.
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Affiliation(s)
- A S Carr
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital of Neurology and Neurosurgery, Queen Square, London, UK.
| | - A L Pelayo-Negro
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital of Neurology and Neurosurgery, Queen Square, London, UK; University Hospital "Marqués de Valdecilla", Department of Neurology, Santander, Spain
| | - Z Jaunmuktane
- Division of Neuropathology, UCL Institute of Neurology and National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - R S Scalco
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital of Neurology and Neurosurgery, Queen Square, London, UK; Division of Neuropathology, UCL Institute of Neurology and National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - D Hutt
- National Amyloidosis Centre, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK
| | - M R B Evans
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - E Heally
- Division of Neuropathology, UCL Institute of Neurology and National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - S Brandner
- Division of Neuropathology, UCL Institute of Neurology and National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - J Holton
- Division of Neuropathology, UCL Institute of Neurology and National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - J Blake
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital of Neurology and Neurosurgery, Queen Square, London, UK; Department of Clinical Neurophysiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - C J Whelan
- National Amyloidosis Centre, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK
| | - A D Wechalekar
- National Amyloidosis Centre, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK
| | - J D Gillmore
- National Amyloidosis Centre, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK
| | - P N Hawkins
- National Amyloidosis Centre, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK
| | - M M Reilly
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
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Carr A, Jaunmuktane Z, Pelayo H, Hutt D, Brandner Holton S, Blake J, Whelan CJ, Wechalekar AD, Gilmore JD, Hawkins PN, Reilly MM. CARDIAC AND EXTRACARDIAC AMYLOIDOSIS IN V122I ATTR. J Neurol Neurosurg Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309236.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fuller J, Kim D, Arnhold E, Sung R, Borden A, Ortega L, Johnson R, Albornoz‐Williams H, Gummin C, Martinez A, Boldt N, Ogunkunle O, Ahn P, Kasten B, Furumo Q, Yorke N, McBride J, Mullooly I, Tripi M, Hutt D, Klestinski K, Kaiser C, Jackson W. The Silent Assassin (LB93). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.lb93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- J. Fuller
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - D. Kim
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - E. Arnhold
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - R. Sung
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - A. Borden
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - L. Ortega
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - R. Johnson
- Marquette University High SchoolMIlwaukeeWIUnited States
| | | | - C. Gummin
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - A. Martinez
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - N. Boldt
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - O. Ogunkunle
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - P. Ahn
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - B. Kasten
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - Q. Furumo
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - N. Yorke
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - J. McBride
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - I. Mullooly
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - M. Tripi
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - D. Hutt
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - K. Klestinski
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - C. Kaiser
- Marquette University High SchoolMIlwaukeeWIUnited States
| | - William Jackson
- Microbiology and Molecular Genetics Medical College of WisconsinMIlwaukeeWIUnited States
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Ovadia R, Hutt D, Nehari M, Bielorai B, Toren A, Nagler A. 4225 Hematopoeitic stem cell donation: the sibling emotional experience. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70842-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Yaffe B, Hutt D, Yaniv Y, Engel J. Major Upper Extremity Replantation. J Reconstr Microsurg 2006. [DOI: 10.1055/s-2006-949040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hutt D, Navon L. Coping patterns of religious and secular parents with their children's cancer. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)81915-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kipen HM, Blume R, Hutt D. Asthma experience in an occupational and environmental medicine clinic. Low-dose reactive airways dysfunction syndrome. J Occup Med 1994; 36:1133-7. [PMID: 7830173 DOI: 10.1097/00043764-199410000-00017] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The etiology of adult-onset asthma is incompletely understood. High-intensity exposure to irritants is one accepted risk factor and such cases are termed Reactive Airways Dysfunction Syndrome. The contribution to asthma of less intense and less acute exposure to irritants remains to be clarified. We report on 10 cases of nonsensitization adult-onset asthma in settings of exposure to noticeable but distinctly "tolerable" levels of inhalation irritants. This series of 10 cases represent 31% of verified asthma cases seen in our environmental and occupational medicine referral clinic over a 5-year period. We believe further exploration of this phenomenon of low dose Reactive Airways Dysfunction Syndrome is warranted.
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Affiliation(s)
- H M Kipen
- Environmental and Occupational Health Sciences Institute, UMDNJ-Robert Wood Johnson Medical School, Piscataway
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Hutt D. Stopping an epidemic of Clostridium difficile diarrhea. Ann Intern Med 1994; 121:307. [PMID: 8037415 DOI: 10.7326/0003-4819-121-4-199408150-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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