ABSTRACT
La amiloidosis siempre ha representado un desafío diagnóstico. En el año 2020, el Grupo de Estudio de Amiloidosis (GEA), confeccionó la Guía de Práctica Clínica para el Diagnóstico de Amiloidosis. Nuevas líneas de investigación se han desarrollado posteriormente. Esta revisión narrativa tiene como intención explorar el estado del arte en el diagnóstico de la amiloidosis. En pacientes con amiloidosis se recomienda la tipificación de la proteína mediante espectrometría de masa, técnica de difícil ejecución por requerir de microdisectores láser para la preparación de la muestra. Algunas publicaciones recientes proponen otros métodos para obtener la muestra de amiloide que se va a analizar, permitiendo prescindir de la microdisección. Por otra parte, en pacientes con Amiloidosis ATTR confirmada, la recomendación de secuenciar el gen amiloidogénico se encontraba destinada a los casos sospechosos de ATTR hereditaria (ATTRv,), pero actualmente esta se ha extendido a todos los pacientes sin importar la edad. En lo que respecta a los estudios complementarios orientados al diagnóstico de compromiso cardíaco, se ha propuesto el uso de la inteligencia artificial para su interpretación, permitiendo la detección temprana de la enfermedad y el correcto diagnóstico diferencial. Para el diagnóstico de neuropatía, las últimas publicaciones proponen el uso de la cadena ligera de neurofilamento sérica, que también podría resultar un indicador útil para seguimiento. Finalmente, con referencia a la amiloidosis AL, la comunidad científica se encuentra interesada en definir qué características determinan el carácter amiloidogénico de las cadenas livianas. La N-glicosilación de dichas proteínas impresiona ser uno de los determinantes en cuestión. (AU)
Amyloidosis has always represented a diagnostic challenge. In 2020, the Amyloidosis Study Group (ASG) developed the "Clinical Practice Guideline for the Diagnosis of Amyloidosis". New lines of research have subsequently emerged. This narrative review aims to explore the state of the art in the diagnosis of amyloidosis diagnosis. In patients with amyloidosis, protein typing by mass spectrometry is recommended, a technique hard to perform because it requires laser microdissection for sample preparation. Recent publications propose other methods to obtain the amyloid sample to be analyzed, making it possible to dispense with microdissection. On the other hand, in patients with confirmed TTR amyloidosis (aTTR), the recommendation to sequence the amyloidogenic gene was intended for suspected cases of hereditary aTTR but has now been extended to all patients regardless of age. (AU)
Subject(s)
Humans , Amyloid Neuropathies, Familial/diagnosis , Early Diagnosis , Amyloidosis/diagnosis , Mass Spectrometry , Biopsy , Glycosylation , Artificial Intelligence , Magnetic Resonance Imaging , Sequence Analysis, DNA , Practice Guidelines as Topic , Diagnosis, Differential , Electrocardiography , High-Throughput Nucleotide SequencingABSTRACT
Limited data exists on patients with cardiac amyloidosis (CA) in India, due to underdiagnosis and late presentation. We present single centre data from 13 patients over a 4 year period with a median age of 65 years. A majority presented with symptomatic heart failure (69%) and eight patients had confirmed AL amyloidosis. At the end of the follow up period, 46% patients died, with 30% of the overall cohort dead within six months. Among the survivors, 71% continue to have NYHA grade III/IV symptoms. A suggested algorithm for earlier diagnosis in resource constrained settings is also presented.
ABSTRACT
El papel del psicólogo clínico en el contexto del consejo genético incluye brindar apoyo a los sujetos en riesgo en el proceso de toma de decisiones, independientemente de la decisión adoptada por el sujeto (conociendo o no el resultado de las pruebas genéticas). El estudio que se informa aborda la motivación para realizar las pruebas pre-sintomáticas (PPS) de sujetos en situación de riesgo para tres enfermedades: polineuropatía amiloide familiar (PAF), la enfermedad de Huntington (EH) y la enfermedad de Machado-Joseph (EMJ) y comparar con la motivación para realizar las PPS para hemocromatosis (HH). La muestra consistió en 213 sujetos portugueses que tenían riesgo genético para contraer las tres enfermedades y 31 sujetos en situación de riesgo genético para contraer hemocromatosis. Ellos fueron evaluados con una entrevista para obtener datos sociodemográficos y debían responder a una pregunta sobre la motivación para llevar a cabo las pruebas pre-sintomáticas. Se obtuvieron siete categorías principales y las siguientes son las más significativas para PAF, EH y EMJ: razones relacionadas con el futuro, razones relacionadas con los demás y razones relacionadas con la curiosidad y la necesidad de conocer. Para hemocromatosis, las más importantes resultaron ser razones relacionadas con los demás y las relacionadas con las características de la enfermedad. La motivación para realizar el test pre-sintomático (PST) de la PAF, EH y EMJ es externa y sin relación con la enfermedad, mientras que la motivación de los sujetos en situación de riesgo para la HH está relacionada con la enfermedad. Las razones relacionadas con los demás es una motivación común en ambos grupos. A los sujetos también les preocupa la posibilidad de transmitir la enfermedad a sus hijos.
The role of the clinical psychologist in the context of genetic counseling includes support for the process of decision-making for subjects at-risk, regardless of the decision that was made. For this, it is important to know the motivations behind these decisions. What may be considered advant-ageous and justifiable reasons to perform the PST for genetic diseases from the medical and public point of view, i.e., planning for the future, helping in the choice of a profession, family planning, improving quality of life and contributing to health, may not be recognized as such by the individual seeking the PST. This study addresses the motivation to perform the presymptomatic testing (PST) of subjects at-risk for three diseases, Familial Amyloid Polyneuro pathy (FAP), Huntington's disease (HD), and Machado-Joseph disease (MJD), compared with the motivation to perform the PST for Hemochromatosis (HH). FAP, HD and MJD are three genetic (monogenic) autosomal dominant late-onset diseases (LON-Ds) with no cure. FAP is a progressive sensorimotor and autonomic neuropathy of adult hood. HD is characterized by a triad of clinical symptoms of chorea (motor, cognitive and psychiatric symptoms), emotional distress and cognitive decline. MJD is characterized by slowly progressive clumsiness in the arms and legs, a staggering lurching gait, sometimes mistaken for drunkenness, difficulty with speech and swallowing, involuntary eye movements, and may be accompanied by double vision or bulging eyes, and lower limb spasticity. HH is a disease in which too much iron accumulates in parenchymal organs, leading to iron overload and subsequent organ toxicity and failure. The study participants consisted in 213 subjects at genetic risk for FAP, HD, and MJD and 31 subjects at genetic risk for HH, that were assessed through an interview to obtain sociodemographic data and the answer to one question about motivation to perform PST: "Which were the reasons that led you to perform the predictive test? "This study was carried out in Center for Predictive and Preventive Genetics (CGPP), Institute for Molecular and Cell Biology (IBMC), Porto (Portugal). This research used a mixed-method, since qualitative and quantitative techniques of data analysis were used. Before deciding to seek genetic counseling and to know their genetic status, subjects at-risk have naturally considered their motives and it was probably the pro-counseling reasons the ones dictating the motivation to perform the PST. This may suggest that in fact there is a prior self-selection to the test, i.e. only those considering to have emotional skills to go through the process, performing the test. Seven major categories were obtained. The most significant ones for FAP, HD and MJD were reasons related to the future, reasons related to others and reasons related to curiosity and to the need to know. For HH, the most important ones were reasons related to others and reasons related to the characteristics of the disease. The motivation of subjects at-risk to perform the PST for FAP, HD and MJD is external and unrelated to the disease, while the motivation of subjects at-risk to perform the PST for HH is related to the disease. Reasons related to others area common motivation: as subjects at-risk for FAP, HD and MJD, subjects at-risk for HH also chose reasons related to others as one of the most important motivations to carry out the PST. These subjects also care about the fact that they can transmit the disease to their children and care about other family members which are already ill. The category reasons related to others includes sub-categories that identify the person and the situation that led to the decision to perform a PST. Subjects at-risk are also concerned about the fact that they have to decide whether or not to have children and its economic implications.
ABSTRACT
Objetivos: considerar as etapas de desenvolvimento do conhecimento sobre a Polineuropatia amiloidótica familiar de Corino Andrade, atualmente conhecida como Amiloidose familiar por transtirretina (TTR) TTR Val30Met - AFTTTRVal30Met; registrar os primórdios e os princípios fundamentais do Centro de Estudos de Paramiloidose Antonio Rodrigues de Mello (CEPARM) de atendimento aos sofredores de doença de herança autossômica dominante sistêmica e com polineuropatia de predomínio sensitivo-motora-autonômica; rever aspectos atuais sobre a doença, etiológicos, epidemiológicos, clínicos, diagnósticos e terapêuticos. Método: Revisão narrativa sobre a AFTTTRVal30Met baseada em: documentos da época da fundação do CEPARM e de seis casos iniciais (além de outros 23 arrolados pelo Centro Português); artigos recentes. Resultados: Três momentos básicos são registrados no desenvolvimento do conhecimento sobre os doentes: 1-o inicial, clínico-patológico (1939-52); 2-da abordagem multiprofissional (1952-80); 3-de melhor conhecimento da sua fisiopatogenia e tentativa de debelá-la ou abrandá-la, aí mencionadas as revelações genômicas e o papel da TTR mutante (TTRm) (1980-91); 4-a partir do transplante hepático e evolução do conhecimento sobre a TTRm (1991-). A criação do CEPARM surgiu na confluência dos momentos dois e três: necessidade de contemplar o atendimento integral aos sofredores da doença ultrapassando a etapa diagnóstica, e início da definição da pré-albumina anômala (TTRm). Conclusão: a abordagem multidisciplinar continua a ser a meta de atendimento aos pacientes com PAF, além das iniciativas ao aprimoramento terapêutico, diagnóstico e profilático da doença, dependentes da aliança com áreas de pesquisa das ciências biológicas.
Objective: to consider the development stages of the knowledge about the Familial amyloid neuropathy of Corino Andrade, currently known as Familial transthyretin (TTR) amyloidosis TTR Val30Met - FTATTR Val30Met; to register the beginnings and the basic principles of the Center of Studies of Paramyloidosis Antonio Rodrigues de Mello (CEPARM) of the disease sufferers consultations: systemic disease, autosomal dominant inheritance, sensorial-motor and autonomic polyneuropathy; to review the current state of knowledge on the illness, etiologic, clinical, epidemiologic, diagnostic and therapeutic. Method: Narrative review about FTAVal30Met based on: documents at the time of CEPARM foundation and the initial cases (beyond 24 others enrolled by the Portuguese Center); recent articles. Results: in the development of the knowledge on the mentioned patients: 1-initial, medical-pathological one (1939-52); 2-of multiprofessional approach (1952-80); 3 of better knowledge of its physiopathogeny and attempt to reduce or eradicate it, the genomics revelations and the paper of the mutant TTR (TTRm) (1980-91); 4-from the first liver transplant and the increasing knowledge about the TTRm (1991-). The creation of the CEPARM appeared in the confluence of moments two and three: necessity to contemplate the integrated management of the patients exceeding the diagnostic stage, and the beginning of the definition of the anomalous pre-albumin (TTRm). Conclusion: the patients' multidisciplinary approach continues to be the main goal of their management, besides the initiatives to improve therapeutic, diagnostic and prophylactics goals, based on the alliance between basic and clinical sciences.
Subject(s)
Humans , Amyloidosis, Familial/diagnosis , Amyloidosis, Familial/therapy , Genetic Counseling , Amyloid Neuropathies, Familial/diagnosis , Amyloidosis/classification , Neurologic Examination , Peripheral Nervous System DiseasesABSTRACT
Objective As SELDI-TOF-MS (Surface Enhanced Laser Desorption/Ionization Time of Flight Mass Spectrometry) has been broadly used to screen biomarkers for a variety of diseases, the identification and validation of the revealed biomarkers requires more focused attention.Method In this paper, the serum samples from 60 cholangiocarcinoma, 146 lung cancer, 65 LGC and 58 LPC, 49 benign diseases of hepatobiliary and 53 normal individuals were analyzed by SELDI-TOF-MS. Results Among a set of proteins automatically selected as specific biomarkers by Biomarker Wizard software, three protein peaks, with molecular weights of 13. 71 × 103 , 13.83 × 103 and 13. 99 ×103 , were found significantly decreased in cholangiocarcinoma samples. The candidate biomarkers obtained from Tricine-SDS-PAGE gel bands by matching the molecular weight with peaks on CM10 chips were identified by Mass spectrometry as the native transthyretin(native TTR),cysTTR and glutTTR.These preliminary results were further proven by immunoprecipitation using commercial TTR antibodies. This allowed us to re-measure the TTR levels in all the groups more simply by ELISA assay. It showed a firm consistency between ELISA and SELDI analysis. In addition, while TTR levels in cholangiocarcinoma were found to be lower than those in normal healthy controls, TTR levels in benign diseases of the hepatobiliary system were found to be higher than those in healthy controls.Conclusion TTR could be a biomarker that better discriminates cholangiocarcinoma patients from the benign diseases compared to other biomarkers presently available.
ABSTRACT
La polineuropatía amiloidótica familiar (PAF) es un tipo de amiloidosis hereditaria. Constituye un desorden autosómico dominante caracterizado por el depósito sistémico de material amiloide en tejidos especialmente en nervios periféricos. El principal componente del amiloide es una variante mutada de la transtiretina (TTR), proteína transportadora de tiroxina y retinol. Han sido descriptas numerosas mutaciones en el gen TTR que causan alteración de la secuencia primaria de la proteína. La PAF portuguesa o PAF Tipo I se origina por la variante TTR Val30Met en la cual una valina en posición 30 es reemplazada por una metionina. Es fundamental la identificación temprana de portadores de la mutación porque una vez declarada la enfermedad el único tratamiento efectivo es el trasplante hepático, órgano de síntesis de la TTR. La PAF Tipo I ha sido muy estudiada en la Argentina debido al hallazgo de un área endémica donde habitan familias descendientes de inmigrantes portugueses. El presente trabajo ha sido enfocado a resolver la necesidad diagnóstica de la comunidad, ya que la ausencia de una metodología apropiada en nuestro país ha impedido, hasta ahora, que individuos con antecedentes familiares de PAF puedan tener un diagnóstico precoz y acceder al trasplante hepático temprano. En consecuencia, nuestro objetivo fue optimizar una metodología para detectar la mutación Val30Met adaptando técnicas previamente descriptas. La fiabilidad, sencillez y rapidez en la obtención de los resultados, así como el requerimiento de pequeño volumen de muestra, hacen que la técnica desarrollada en este trabajo sea una herramienta apropiada para procedimientos de screening, permitiendo contar con un marcador preclínico de la enfermedad.
Familial amyloid polyneuro- pathy (FAP) is an autosomal dominant inherited disease, characterized by systemic deposition of amyloid fibrils in various tissues, especially in peripheral nerves, being a variant of transthyretin (TTR) the principal component of amyloid fibrils. TTR is a normal plasma protein (previously called prealbumin) that functions as a transport protein binding tiroxine and retinol. Among many mutations that have been found in the TTR gene, the variant with a single amino acid substitution of methionine for valine at position 30 (TTR Val30Met) is the responsible of the Portuguese-type Familial Amyloidotic Polyneuropathy (FAP Type I). Interest in this pathology has arisen in Argentina because of the finding of an endemic area where a group of Portuguese immigrant families is localized. Since liver transplantation is a widely accepted treatment because it results in the disappearance of variant transthyretin from plasma, an early detection of the altered gene is essential. Thus, the objective of the present work was to optimize a methodology to detect the Val30Met mutation introducing modifications into techniques that were previously developed. The simple method here described is useful to confirm the diagnosis of the potential disease and, therefore, make it possible for patients to gain access to early liver transplantation.