RÉSUMÉ
Resumen Introducción: La amiloidosis hereditaria mediada por transtirretina es una enfermedad autosómica dominante, con compromiso sistémico y progresivo, que altera la función de múltiples órganos, y se asocia con una alta morbilidad y mortalidad. Se presenta compromiso neurológico, cardiaco, autonómico, oftalmológico y nefrológico, entre otros, que se relacionan con el genotipo del paciente. Estas alteraciones afectan la calidad de vida y tienen una relación directa con la mortalidad temprana en estos pacientes. La neuropatía periférica es un marcador temprano de la enfermedad. Su identificación permite un tratamiento temprano con terapias modificadoras de la enfermedad, en busca de la estabilización de la progresión de la enfermedad, lo cual, acompañado de un seguimiento adecuado, tiene un impacto positivo en la calidad de vida de los pacientes y una prolongación de la expectativa de vida. Objetivo: Estructurar una serie de recomendaciones adecuadas al entorno local sobre el tratamiento y seguimiento en pacientes con amiloidosis hereditaria mediada por transtirretina. Materiales y método: Se utilizó la metodología Delphi y se estableció como punto de corte un 75% de favorabilidad. Resultados y conclusiones: Se plantearon una serie de recomendaciones basadas en la evidencia disponible y las recomendaciones internacionales, aplicables al entorno local, sobre métodos diagnósticos que faciliten la detección temprana del paciente afectado y los parámetros de inicio del tratamiento y el seguimiento que mejoren la calidad de vida, disminuyan las complicaciones y aumenten la expectativa de vida de estos pacientes.
Abstract Introducción: Transthyretin-mediated hereditary amyloidosis is an autosomal dominant disease with progressive systemic involvement that affects the function of multiple organs and is associated with high morbidity and mortality. Patients present neurological, cardiac, autonomic, ophthalmological and renal involvement, among others, related to the patient's genotype. These alterations affect quality of life and are directly related to early mortality. Peripheral neuropathy is an early marker of the disease. Its identification allows early treatment with disease-modifying therapies aimed at stabilizing disease progression, which, along with adequate follow-up, has a positive impact on patients' quality of life and prolongs life expectancy. Objective: To structure a series of recommendations appropriate to the local setting on treatment and follow-up in patients with hereditary transthyretin-mediated amyloidosis. Materials and methods: Delphi methodology was used, and a cut-off point of 75% favorability was established. Results and conclusions: A series of recommendations were presented based on the available evidence and international recommendations, applicable to the local setting, on diagnostic methods that facilitate early detection of the affected patient and the parameters for initiation of treatment and follow-up that improve the quality of life, decrease complications, and increase the life expectancy of these patients.
RÉSUMÉ
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.