{"title":"Genetic counselling for at-risk family members with hereditary transthyretin amyloidosis: data from a single-centre study.","authors":"Katsuya Nakamura, Tsuneaki Yoshinaga, Akiko Sakyu, Akira Matsushima, Yuka Yonehara, Tomomi Kojima, Masumi Ishikawa, Emiko Kise, Tomoki Kosho, Yoshiki Sekijima","doi":"10.1080/13506129.2024.2357094","DOIUrl":"10.1080/13506129.2024.2357094","url":null,"abstract":"<p><strong>Background: </strong>Hereditary transthyretin-related amyloidosis is an autosomal dominant disorder. Recently, disease-modifying therapies (DMTs) have been developed. For at-risk individuals, genetic analysis aids in the early administration of medical care; however, few studies have evaluated the current status of genetic counselling and management of presymptomatic carriers of amyloidogenic variants.</p><p><strong>Methods: </strong>We retrospectively evaluated the medical records of 202 consecutive participants.</p><p><strong>Results: </strong>A total of 103 clients who received genetic counselling for predictive testing were at-risk, and 83 underwent predictive testing. Genetic testing results were positive in 33 patients, 11 of whom had confirmed amyloid deposition and were administered DMTs. For presymptomatic V30M (p.V50M) carriers, 32.0 ± 2.4 years (median ± standard error) was the age when amyloid deposition was first identified (95% confidence interval 27.4-36.6). Serum transthyretin (TTR) levels decreased serially with an estimated slope of -1.2 mg/dL/year.</p><p><strong>Conclusions: </strong>Our study suggests the clinical utility of management using a combination of predictive testing and monitoring methods. Psychosocial support should be considered with collaboration between geneticists/genetic counsellors and psychologists. For a more optimised protocol for monitoring and designing future interventional trials in presymptomatic carriers, prospective cohort studies are necessary to clarify the natural history, particularly in the early stages of the disease.</p>","PeriodicalId":50964,"journal":{"name":"Amyloid-Journal of Protein Folding Disorders","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141096812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Danai Dima, Michael Hughes, Mark Orland, Fauzia Ullah, Utkarsh Goel, Faiz Anwer, Shahzad Raza, Sandra Mazzoni, Divaya Bhutani, Louis Williams, Suzanne Lentzsch, Christy Samaras, Jason Valent, Rajshekhar Chakraborty, Jack Khouri
{"title":"Outcomes of venetoclax-based therapy in patients with t(11;14) light chain amyloidosis after failure of daratumumab-based therapy.","authors":"Danai Dima, Michael Hughes, Mark Orland, Fauzia Ullah, Utkarsh Goel, Faiz Anwer, Shahzad Raza, Sandra Mazzoni, Divaya Bhutani, Louis Williams, Suzanne Lentzsch, Christy Samaras, Jason Valent, Rajshekhar Chakraborty, Jack Khouri","doi":"10.1080/13506129.2024.2366806","DOIUrl":"10.1080/13506129.2024.2366806","url":null,"abstract":"<p><strong>Background: </strong>Daratumumab's incorporation in the upfront treatment of light chain (AL) amyloidosis has led to daratumumab (dara) refractoriness early in disease course. Patients who experience relapse or have suboptimal response to dara-based-therapy, have limited options.</p><p><strong>Objective: </strong>This study aimed to evaluate the outcomes of venetoclax-based therapy in t(11;14) positive AL patients who previously failed dara.</p><p><strong>Methods: </strong>Thirty-one patients with AL were included in this bi-institutional retrospective analysis.</p><p><strong>Results: </strong>Dara failure was due to inadequate response in 20 (65%) patients, haematologic relapse in 7 (22%), and both haematologic plus organ relapse in 4 (13%). Overall haematologic response rate to venetoclax-based therapy was 97%, with ≥ VGPR being 91%. Of the 19 evaluable patients with cardiac involvement, 14 (74%) achieved organ response. Of the 13 evaluable patients with renal involvement, 6 (46%) achieved organ response. With a median follow-up of 22 months, median time-to-next-treatment (TTNT) and overall survival (OS) were not reached. The 12- and 24-month TTNT rates were 74% and 56%, respectively. At data-cut-off, four patients had died, all from AL-related organ complications. The 12- and 24-month OS rates were 89% and 85%, respectively. Grade ≥3 adverse events occurred in 26% of patients, with 6% due to infections.</p><p><strong>Conclusion: </strong>These findings are encouraging for the use of venetoclax as salvage therapy post-dara failure.</p>","PeriodicalId":50964,"journal":{"name":"Amyloid-Journal of Protein Folding Disorders","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141494182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Internalisation of immunoglobulin light chains by cardiomyocytes in AL amyloidosis: what can biopsies tell us?","authors":"Mélanie Bézard, Amira Zaroui, Mounira Kharoubi, France Lam, Elsa Poullot, Emmanuel Teiger, Onnik Agbulut, Thibaud Damy, Ekaterini Kordeli","doi":"10.1080/13506129.2024.2373748","DOIUrl":"10.1080/13506129.2024.2373748","url":null,"abstract":"<p><strong>Background: </strong>Cardiac involvement in systemic light chain amyloidosis (AL) leads to chronic heart failure and is a major prognosis factor. Severe cellular defects are provoked in cardiac cells by tissue-deposited amyloid fibrils of misfolded free immunoglobulin light chains (LCs) and their prefibrillar oligomeric precursors.</p><p><strong>Objective: </strong>Understanding the molecular mechanisms behind cardiac cell cytotoxicity is necessary to progress in therapy and to improve patient management. One key question is how extracellularly deposited molecules exert their toxic action inside cardiac cells. Here we searched for direct evidence of amyloid LC uptake by cardiomyocytes in patient biopsies.</p><p><strong>Methods: </strong>We immunolocalized LCs in cardiac biopsies from four AL cardiac amyloidosis patients and analysed histopathological images by high resolution confocal microscopy and 3D image reconstruction.</p><p><strong>Results: </strong>We show, for the first time directly in patient tissue, the presence of LCs inside cardiomyocytes, and report their proximity to nuclei and to caveolin-3-rich areas. Our observations point to macropinocytosis as a probable mechanism of LC uptake.</p><p><strong>Conclusions: </strong>Internalisation of LCs occurs in patient cardiomyocytes. This event could have important consequences for the pathogenesis of the cardiac disease by enabling interactions between amyloid molecules and cellular organelles inducing specific signalling pathways, and might bring new insight regarding treatment.</p>","PeriodicalId":50964,"journal":{"name":"Amyloid-Journal of Protein Folding Disorders","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Janett Köppen, Martin Kleinschmidt, Markus Morawski, Jens-Ulrich Rahfeld, Michael Wermann, Holger Cynis, Ute Hegenbart, Christoph Daniel, Steffen Roßner, Stephan Schilling, Anja Schulze
{"title":"Identification of isoaspartate-modified transthyretin as potential target for selective immunotherapy of transthyretin amyloidosis.","authors":"Janett Köppen, Martin Kleinschmidt, Markus Morawski, Jens-Ulrich Rahfeld, Michael Wermann, Holger Cynis, Ute Hegenbart, Christoph Daniel, Steffen Roßner, Stephan Schilling, Anja Schulze","doi":"10.1080/13506129.2024.2358121","DOIUrl":"10.1080/13506129.2024.2358121","url":null,"abstract":"<p><strong>Background: </strong>Numerous studies suggest a progressive accumulation of post-translationally modified peptides within amyloid fibrils, including isoaspartate (isoD) modifications. Here, we generated and characterised novel monoclonal antibodies targeting isoD-modified transthyretin (TTR). The antibodies were used to investigate the presence of isoD-modified TTR in deposits from transthyretin amyloidosis patients and to mediate antibody-dependent phagocytosis of TTR fibrils.</p><p><strong>Methods: </strong>Monoclonal antibodies were generated by immunisation of mice using an isoD-modified peptide and subsequent hybridoma generation. The antibodies were characterised in terms of affinity and specificity to isoD-modified TTR using surface plasmon resonance, transmission electron microscopy and immunohistochemical staining of human cardiac tissue. The potential to elicit antibody-dependent phagocytosis of TTR fibrils was assessed using THP-1 cells.</p><p><strong>Results: </strong>We developed two mouse monoclonal antibodies, 2F2 and 4D4, with high nanomolar affinity for isoD-modified TTR and strong selectivity over the unmodified epitope. Both antibodies show presence of isoD-modified TTR in human cardiac tissue, but not in freshly purified recombinant TTR, suggesting isoD modification only present in aged fibrillar deposits. Likewise, the antibodies only facilitated phagocytosis of TTR fibrils and not TTR monomers by THP-1 cells.</p><p><strong>Conclusions: </strong>These antibodies label aged, non-native TTR deposits, leaving native TTR unattended and thereby potentially enabling new therapeutic approaches.</p>","PeriodicalId":50964,"journal":{"name":"Amyloid-Journal of Protein Folding Disorders","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Steven A Muller, Anouk Achten, Manon G van der Meer, Peter-Paul Zwetsloot, Sandra Sanders-van Wijk, Pim van der Harst, J Peter van Tintelen, Anneline S J M Te Riele, Vanessa van Empel, Christian Knackstedt, Marish I F J Oerlemans
{"title":"Absence of an increased wall thickness does not rule out cardiac amyloidosis.","authors":"Steven A Muller, Anouk Achten, Manon G van der Meer, Peter-Paul Zwetsloot, Sandra Sanders-van Wijk, Pim van der Harst, J Peter van Tintelen, Anneline S J M Te Riele, Vanessa van Empel, Christian Knackstedt, Marish I F J Oerlemans","doi":"10.1080/13506129.2024.2348681","DOIUrl":"10.1080/13506129.2024.2348681","url":null,"abstract":"","PeriodicalId":50964,"journal":{"name":"Amyloid-Journal of Protein Folding Disorders","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141066404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rola Khedraki, Joseph El-Roumi, Daniela Allende, Lauren Ives, Ari Garber, Alberto RubioTapia, Jean Paul Achkar, Michael Cline, Brian Baggott, Benjamin Cohen, Florian Rieder, Mazen Hanna
{"title":"Gastrointestinal Amyloid Screening Study (GASS): is screening for amyloid in the gastrointestinal tract useful?","authors":"Rola Khedraki, Joseph El-Roumi, Daniela Allende, Lauren Ives, Ari Garber, Alberto RubioTapia, Jean Paul Achkar, Michael Cline, Brian Baggott, Benjamin Cohen, Florian Rieder, Mazen Hanna","doi":"10.1080/13506129.2024.2347493","DOIUrl":"10.1080/13506129.2024.2347493","url":null,"abstract":"","PeriodicalId":50964,"journal":{"name":"Amyloid-Journal of Protein Folding Disorders","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141071702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paolo Milani, Francesca Fabris, Roberta Mussinelli, Giuseppe Damiano Sanna, Marco Basset, Pietro Benvenuti, Claudia Bellofiore, Martina Nanci, Mario Nuvolone, Andrea Attanasio, Gianluigi Guida, Stefano Perlini, Andrea Foli, Giampaolo Merlini, Giovanni Palladini
{"title":"Delayed identification of monoclonal protein is associated with early death in isolated cardiac AL amyloidosis.","authors":"Paolo Milani, Francesca Fabris, Roberta Mussinelli, Giuseppe Damiano Sanna, Marco Basset, Pietro Benvenuti, Claudia Bellofiore, Martina Nanci, Mario Nuvolone, Andrea Attanasio, Gianluigi Guida, Stefano Perlini, Andrea Foli, Giampaolo Merlini, Giovanni Palladini","doi":"10.1080/13506129.2024.2374904","DOIUrl":"10.1080/13506129.2024.2374904","url":null,"abstract":"<p><strong>Background: </strong>Early identification of immunoglobulin light-chain amyloidosis (AL) is crucial due to its rapid progression. Monoclonal light-chain (M-LC) testing is the first step in the diagnostic workup for patients with suspected cardiac amyloidosis (CA). We aimed to determine whether the time interval between the first CA suspicion and M-LC testing can be related to AL amyloidosis survival outcomes.</p><p><strong>Methods: </strong>All patients (<i>n</i> = 94) with isolated cardiac AL amyloidosis diagnosed at our center between 2016 and 2020 were included. Those with pre-existing known monoclonal protein (monoclonal gammopathy of undetermined significance or smoldering multiple myeloma) were excluded. Time intervals to diagnostic tests and diagnosis were calculated and assessed for their survival prediction ability.</p><p><strong>Results: </strong>The time interval between first CA suspicion (on echocardiography) and M-LC testing correlated with early mortality, and the best cutoff predicting survival, was 6 weeks. The 26 patients (∼28% of entire cohort) who underwent M-LC-studies >6 weeks after first suspicion more frequently presented Mayo stage IIIb (65% vs. 35%, <i>p</i> = .008), showing poorer overall survival than those (<i>n</i> = 68, 72%) referred for early M-LC studies (median 3 vs. 14 months, <i>p</i> = .039).</p><p><strong>Conclusions: </strong>Monoclonal protein testing should be the first-step in the diagnostic workup for patients with echocardiographic/other instrumental red flags raising CA suspicion.</p>","PeriodicalId":50964,"journal":{"name":"Amyloid-Journal of Protein Folding Disorders","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diana Canetti, Graham W Taylor, Francesca Lavatelli, Christoph Röcken
{"title":"A report from the European Proteomics Amyloid Network (EPAN).","authors":"Diana Canetti, Graham W Taylor, Francesca Lavatelli, Christoph Röcken","doi":"10.1080/13506129.2024.2392185","DOIUrl":"https://doi.org/10.1080/13506129.2024.2392185","url":null,"abstract":"","PeriodicalId":50964,"journal":{"name":"Amyloid-Journal of Protein Folding Disorders","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Luísa Sousa, Catarina Pinto, Ana Azevedo, Liliana Igreja, Ana Marta, Joana Fernandes, Pedro Oliveira, Márcio Cardoso, Cristina Alves, Ana Martins da Silva, Miguel Mendonça Pinto, Ana Paula Sousa, Teresa Coelho, Ricardo Taipa
{"title":"Brain MRI in patients with V30M hereditary transthyretin amyloidosis.","authors":"Luísa Sousa, Catarina Pinto, Ana Azevedo, Liliana Igreja, Ana Marta, Joana Fernandes, Pedro Oliveira, Márcio Cardoso, Cristina Alves, Ana Martins da Silva, Miguel Mendonça Pinto, Ana Paula Sousa, Teresa Coelho, Ricardo Taipa","doi":"10.1080/13506129.2024.2391842","DOIUrl":"https://doi.org/10.1080/13506129.2024.2391842","url":null,"abstract":"<p><strong>Background: </strong>Central nervous system dysfunction is common in longstanding hereditary transthyretin amyloidosis (ATTRv) caused by the V30M (p.V50M) mutation. Neuropathology studies show leptomeningeal amyloid deposition and cerebral amyloid angiopathy (CAA). Brain MRI is widely used in the assessment of Aβ associated CAA but there are no systematic studies with brain MRI in ATTRv amyloidosis.</p><p><strong>Methods: </strong>we performed 3 T brain MRIs in 16 patients with longstanding (>14 years) ATTRV30M. We additionally retrospectively reviewed 48 brain MRIs from patients followed at our clinic. CNS symptoms and signs were systematically accessed, and MRIs were blindly reviewed for ischaemic and haemorrhagic lesions.</p><p><strong>Results: </strong>in the prospective cohort, we found white matter hyperintensities in 8/16 patients (50%, Fazekas score> =1). There were no relevant microbleeds, large ischaemic or haemorrhagic lesions or superficial siderosis. In the retrospective cohort, microbleeds were found in 5/48 patients (10,4%), two of which with > =20 microbleeds. White matter hyperintensities were found in 20/48 cases (41.7%). White matter lesions, microbleeds and cortical atrophy were not associated with disease duration.</p><p><strong>Conclusions: </strong>white matter hyperintensities are common in ATTRV30M, irrespective of disease duration. Haemorrhagic lesions are rare, even in patients with longstanding disease, suggesting the existence of other risk factors.</p>","PeriodicalId":50964,"journal":{"name":"Amyloid-Journal of Protein Folding Disorders","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}