New insights into the clinical evaluation of hereditary transthyretin amyloidosis patients: a single center's experience

Abstract

Over the last decade, new medical treatment modalities have emerged based on increased insights into amyloid formation. With the increased possibilities for treatment of amyloidosis caused by transthyretin (TTR) amyloid deposits comes the need for diagnostic procedures for early diagnosis and better tools to follow disease progression. This is of particular importance in clinical trials evaluating the efficacy of new treatments. Until recently, the treatment of TTR amyloidosis (ATTR) was based solely on liver transplantation, a procedure that has halted disease progression in many patients. Liver transplantation has been especially effective in patients under the age of 50 years carrying the TTR V30M mutation, whereas the outcome of the procedure has been variable for others, particularly elderly male patients and those carrying a non-V30M mutation. This review concentrates on new insights derived from our center's experience with liver transplantation, how to implement this experience in evaluation of new treatment modalities for ATTR, and how to facilitate early diagnosis of neuropathy with easily available diagnostic tools. Attention has focused on manifestations of the disease that involve the heart and the peripheral nervous system; change in peripheral nerve function has been the primary endpoint in two controlled clinical trials, one finished and one ongoing. New insights into the amyloid formation process and the lessons learned from liver transplantation give the opportunity to design potentially effective treatment modalities for ATTR. It appears reasonable to suspect that a combination of different treatment modalities may be required to treat the disease, and that different treatment regimes will be designed according to the phenotype of the disease. For the patients and their relatives there is now a solid foundation for optimism, with prospects of several effective medical treatment possibilities within the coming decade.

A Hyperdimensional Computing Framework for Analysis of Cardiorespiratory Synchronization During Paced Deep Breathing

“…A significant number of both CAN and MI patients presented with reduced HRV, as shown in Fig 7. Since subjects were instructed when and how to inhale and exahale all breaths, the low DBI scores cannot be explained by a low tidal volume. Therefore, these results confirms previous findings based on other HRV protocols that cardiac autonomic dysfunction is common in both patient groups [8], [27].…”

Systemic Amyloidosis Recognition, Prognosis, and Therapy

“…In variant forms of ATTR amyloidosis, the clinical phenotype is driven by the type of sequence variation. The most commonly recognized sequence variation worldwide presents with peripheral neuropathy (ATTR V30M) . The most common sequence variation seen in the US (ATTR T60A) has a dominant cardiomyopathy phenotype .…”

“…The most commonly recognized sequence variation worldwide presents with peripheral neuropathy (ATTR V30M). 9 The most common sequence variation seen in the US (ATTR T60A) has a dominant cardiomyopathy phenotype. 10 The ATTR V122I variation in black individuals is predominantly cardiac, although mild neuropathy may be present.…”

Normal scores of deep breathing tests: beware of dysrhythmia in transthyretin amyloidosis

“…This study is focussed on the validity of the DB test in patients with hereditary transthyretin amyloid (ATTRm) amyloidosis. ATTRm amyloidosis is a severe disease where marked abnormalities in the cardiac autonomic regulation are common [5], as well as cardiac arrhythmias and conduction disturbances [6,7]. Since 1990, liver transplantation has been the only treatment available to halt the progression of ATTRm amyloidosis.…”