Presentation
PDF Merrill Benson and Isis = Presentation PDF Teresa M Kruisselbrink, CGC Presentation PDF A.K. [amyloidosissupport.org]
A 70-year-old man presented with a personal history of type 2 diabetes and former alcohol dependency (wine, moderate). [ruralneuropractice.com]
The present study aimed to compare the change in quality of life following liver transplantation between patients with Familial Amyloid Polyneuropathy (FAP) and patients with liver disease. [ncbi.nlm.nih.gov]
Article 9 Stateless persons The regime of the present diploma shall be applicable to stateless persons working in Portuguese territory. [cidadevirtual.pt]
It is most frequently seen in patients with hereditary transthyretin (TTR) amyloidosis, but is also present in 20% of patients with systemic immunoglobulin light chain (primary) amyloidosis. [indiana.pure.elsevier.com]
Entire Body System
- Amyloidosis
Diagnosis - Hereditary ATTR amyloidosis Prognosis - Hereditary ATTR amyloidosis Not supplied. Treatment - Hereditary ATTR amyloidosis Resources - Hereditary ATTR amyloidosis [checkorphan.org]
[…] cardiac amyloidosi,s Inherited systemic amyloidosis, Neuropathic (Portuguese) (Swiss) amyloidosis, Secondary amyloidosis [genedx.com]
The organs affected may depend on whether the amyloidosis is the primary, secondary, or hereditary form A group of diseases in which protein is deposited in specific organs (localized amyloidosis) or throughout the body (systemic amyloidosis). [icd9data.com]
ATTR Familial Amyloidosis The clinical features of ATTR amyloidosis overlap AL amyloidosis such that the diseases cannot be reliably distinguished on clinical grounds alone. [web.archive.org]
- Pain
In severe painful conditions patients may be referred to the Blaustein Chronic Pain Clinic for a multidisciplinary approach to pain management. Thank you for your interest in the Johns Hopkins Peripheral Nerve Center. [hopkinsmedicine.org]
Both groups had progressive loss of pain and temperature appreciation, beginning distally in the feet. In HSAN, the median sensory nerve action potentials (SNAP) were lost early, but the sympathetic skin responses (SSR) were always preserved. [ncbi.nlm.nih.gov]
NON-NEUROLOGIC Classification Associated features Protein component SecondaryRheumatoid arthritis Inflammatory disorders Leprosy : Chronic Serum Amyloid A (SAA) SAA1 & SAA2 ; SAA4 Familial Mediterranean fever (FMF) Renal disease Abdominal pain SAA 1° [neuromuscular.wustl.edu]
These erosions alter the cornea's normal curvature, resulting in temporary vision problems, and expose the nerves that line the cornea, causing severe pain. Even the involuntary act of blinking can be painful. [en.wikipedia.org]
- Weakness
Neurol India 2012;60:430-1 Sir, A-30-old man presented with weakness and numbness of left foot and leg of 3 years duration and similar complaints in right lower limb of 2 years duration. [neurologyindia.com]
Neuropathy caused by FAP is characterized by numbness, tingling, weakness or pain in the arms or legs, and loss of sensation. Other symptoms include a steep drop in blood pressure, dizziness, diarrhea, constipation, nausea, and reduced sweating. [diseaseinfosearch.org]
The motor involvement occurs late in the disease, initially in the lower limbs, progressing to atrophy and weakness, predominantly observed in the feet and legs. Involvement of the upper limbs occurs later. [ceparm.com]
Generalized symptoms include: Extreme weakness and tiredness Loss of appetite Unexplained loss of weight Irritable bowel syndrome and digestive problems Obstructive sleep apnea that may give rise to snoring Erectile dysfunction or impotence Skin lesions [news-medical.net]
Transthyretin amyloidosis: a tale of weak interactions. FEBS Lett. 2001;498:201-203. Floege J, Schaffer J, Koch KM. Scintigraphic methods to detect beta2-microglobulin associated amyloidosis (Abeta2-microglobulin amyloidosis). [rarediseases.org]
- Asymptomatic
Results of ophthalmologic examination showed asymptomatic lattice corneal dystrophy of both eyes, but the appearance of the cornea was different from that described in the patients from Finland. [ncbi.nlm.nih.gov]
In inherited cardiac TTR-cardiomyopathy, the typical clinical picture of cardiovascular involvement ranges from asymptomatic atrioventricular and bundle branch block to severe and rapidly progressive heart failure owing to the significant restrictive [thaos.net]
Due to symptomatic bradyarrhythmia a dual-chamber pacing system (DDDR mode) was implanted, and the patient remained asymptomatic for the next five years. [elsevier.pt]
[…] of amyloidosis and asymptomatic relatives with the variant gene carry the V30M variant. [emedicine.medscape.com]
The clinical spectrum of cardiovascular involvement is wide, ranging from asymptomatic AV and bundle branch block to severe, rapidly progressive heart failure due to restrictive pathophysiology. [ojrd.biomedcentral.com]
- Progressive Polyneuropathy
Finnish-type familial amyloidosis (FAP-IV) is an autosomal, dominantly inherited disorder characterized by progressive polyneuropathy and lattice corneal dystrophy type II. The vast majority of families with this disorder originated from Finland. [ncbi.nlm.nih.gov]
Araki S and Ando Y (2010) Transthyretin‐related familial amyloidotic polyneuropathy – Progress in Kumamoto, Japan (1967–2010). Proceedings of the Japan Academy, Series B 86: 694–697. Chalk C (2012) A designer drug for amyloid polyneuropathy. [els.net]
Respiratoric
- Dyspnea
The previous year (January 2014), the patient visited the Emergency Department with symptoms of dyspnea with mild exertion and subacute onset of edema of the lower limbs. [ruralneuropractice.com]
Patients with cardiac deposition typically present with the following typical symptoms of chronic heart failure (CHF): Symptoms suggestive of right-sided CHF (ie, dyspnea on exertion, peripheral edema, hepatomegaly, ascites, and elevated jugular venous [emedicine.medscape.com]
Gastrointestinal
- Diarrhea
This diarrhea can be temporarily alleviated by co-trimoxazole treatment. [ncbi.nlm.nih.gov]
He later developed cardiac symptoms and diarrhea. Urine laboratory analyses revealed a monoclonal spike of light chains (kappa). Biopsies of abdominal fat and bone marrow yielded normal results. [ruralneuropractice.com]
Or you could have problems like diarrhea, constipation, feeling full as soon as you start eating, and trouble peeing. You might also feel very tired. [webmd.com]
Other symptoms include a steep drop in blood pressure, dizziness, diarrhea, constipation, nausea, and reduced sweating. These symptoms can begin as early as young adulthood but may not occur until old age. [diseaseinfosearch.org]
Autonomic neuropathy is manifest by gastrointestinal symptoms of diarrhea with weight loss and orthostatic hypotension. [web.archive.org]
- Nausea
Other symptoms include a steep drop in blood pressure, dizziness, diarrhea, constipation, nausea, and reduced sweating. These symptoms can begin as early as young adulthood but may not occur until old age. [diseaseinfosearch.org]
Patients may experience painful paresthesias (unusual sensations), numbness and balance difficulties due to sensory dysfunction and persistent nausea, vomiting, diarrhea, constipation, incontinence, sweating abnormalities or sexual dysfunction due to [hopkinsmedicine.org]
If there is vomiting and diarrhea, careful administration of intravenous fluids and anti‑nausea drugs may be necessary. [ttrstudy.com]
Intravenous fluids and anti‑nausea drugs may be necessary, but it is important to avoid fluid overload if there is heart disease. [amyloidosis.org.uk]
Other gastrointestinal dysfunctions may require treatment for symptoms that include poor nutritional health, diarrhea or constipation, and nausea or vomiting. [amyloidosis.org]
- Vomiting
Autonomic neuropathy usually manifests with orthostatic hypotension, constipation alternating with diarrhea, vomiting, impotence or hypohidrosis. [genedx.com]
Patients may experience painful paresthesias (unusual sensations), numbness and balance difficulties due to sensory dysfunction and persistent nausea, vomiting, diarrhea, constipation, incontinence, sweating abnormalities or sexual dysfunction due to [hopkinsmedicine.org]
If there is vomiting and diarrhea, careful administration of intravenous fluids and anti‑nausea drugs may be necessary. [ttrstudy.com]
Care should be taken to avoid dehydration if there is vomiting and diarrhoea. Intravenous fluids and anti‑nausea drugs may be necessary, but it is important to avoid fluid overload if there is heart disease. [amyloidosis.org.uk]
Other gastrointestinal dysfunctions may require treatment for symptoms that include poor nutritional health, diarrhea or constipation, and nausea or vomiting. [amyloidosis.org]
Eyes
- Visual Impairment
Leptomeningeal amyloidosis aka oculoleptomeningeal amyloidosis affects predominantly the central nervous system, sometimes combined with visual impairment. [genedx.com]
In addition, renal manifestations or visual impairment may occur, although less frequently. Overall, the course of the disease is pejorative in 8–15 years. [nature.com]
- Visual Impairment
Leptomeningeal amyloidosis aka oculoleptomeningeal amyloidosis affects predominantly the central nervous system, sometimes combined with visual impairment. [genedx.com]
In addition, renal manifestations or visual impairment may occur, although less frequently. Overall, the course of the disease is pejorative in 8–15 years. [nature.com]
Urogenital
- Kidney Failure
In systemic cases, kidney failure, heart failure and neuropathy such as facial nerve palsy, laxity of the skin may be noted. [2] Genetics [ edit ] Lattice corneal dystrophy type II. [en.wikipedia.org]
Primary amyloidosis is the second most frequent hematological condition associated with a monoclonal protein. [4] Symptoms depend on the organs affected by the deposits and may include myocardiopathy, liver disease, kidney failure, lingual hypertrophy [ruralneuropractice.com]
[…] in the urine, kidney failure, goiter (thyroid swelling), etc. [ttrstudy.com]
In some cases, the amyloid deposits will cause the kidneys to lose the ability to purify the blood, which can lead to kidney failure; also known as “renal” failure. These patients may need dialysis to replace the function of the kidneys. [amyloidosis.org]
- Renal Insufficiency
Four inotersen-treated patients discontinued treatment due to a renal observation; two patients met a predefined renal stopping rule and two experienced serious renal adverse events, one of whom experienced chronic renal insufficiency. [spjnews.com]
Neurologic
- Polyneuropathy
Heterogeneity of penetrance in familial amyloid polyneuropathy, ATTR Val30Met, in the Swedish population. Amyloid 15, 181–186 (2008). 7. Ohya, Y. et al. [doi.org]
A sporadic case of late-onset familial amyloid polyneuropathy with a monoclonal gammopathy. Neuromuscul Disord 2015;25:658-60. [Figure 1], [Figure 2], [Figure 3] [ruralneuropractice.com]
Background: Liver transplantation holds promise as a treatment for familial amyloid polyneuropathy. Objective: To determine whether peripheral nerves regenerate in patients with familial amyloid polyneuropathy after liver transplantation. [annals.org]
Nevertheless, quality of life improvement in specific groups of transplanted patients such as those with Familial Amyloid Polyneuropathy has not yet been explored. [ncbi.nlm.nih.gov]
Familial Amyloidotic Polyneuropathy World Transplant Registry. www.fapwtr.org. Suhr OB, Friman S, Ericzon BG: Early liver transplantation improves familial amyloidotic polyneuropathy patients' survival. Amyloid 2005;12:233-238. [karger.com]
- Peripheral Neuropathy
Academic Close See also Companion Articles From The Archives More on this topic Occurrence and characterization of peripheral nerve involvement in neurofibromatosis type 2 PERIPHERAL NEUROPATHY IN TANGIER DISEASE Transthyretin Leu12Pro is associated [doi.org]
Features of Textbook of Peripheral Neuropathy Include : ̈ Practical yet comprehensiveóan accessible ìgo-toî reference for clinicians ̈ Covers all clinically relevant peripheral neuropathies ̈ Clinical Pearls and Key Points are set off from the text for [books.google.com]
"A peculiar form of peripheral neuropathy; familiar atypical generalized amyloidosis with special involvement of the peripheral nerves". Brain. 75 (3): 408–27. doi : 10.1093/brain/75.3.408. PMID 12978172. ↑ Kelly JW (February 1996). [ipfs.io]
Within each family disease begins at nearly the same age and symptoms usually include neuropathy and/or cardiomyopathy. Peripheral neuropathy begins as a lower extremity sensory and motor neuropathy and progresses to the upper extremities. [web.archive.org]
CrossRef Google Scholar Cohen, A.S., and Rubinow, A. (1984) ‘Amyloid neuropathy’, in P.J. Dyck, P.K. Thomas, E.H. Lambert, R. Bunge (eds), Peripheral Neuropathy, Vol. II, Philadelphia, W.B. Saunders, pp. 1866–1898. [link.springer.com]
Workup
Imaging studies Radiolabeled P-component scanning Cardiac imaging (eg, 2-dimensional echocardiography, electrocardiography, or both; CT scanning; nuclear scintigraphy, cardiac MRI) See Workup for more detail. [emedicine.medscape.com]
Following this workup the patient should undergo a DNA analysis and tissue biopsy (Table 1 ), although the uneven distribution of amyloid fibrils may yield false-negative results. [ojrd.biomedcentral.com]
Treatment
This diarrhea can be temporarily alleviated by co-trimoxazole treatment. [ncbi.nlm.nih.gov]
With no FDA-approved drugs, treatment options are extremely limited and desperately needed.” [spjnews.com]
Continued Treatment Treatment of TTR-FAP depends on your symptoms and how far your condition has developed. The goal of some treatment is to ease the symptoms that are caused when too much amyloid gathers in your organs. [webmd.com]
[…] of Rare Diseases (2018) Cardiac Amyloidosis: Diagnosis and Treatment Strategies Mirela Tuzovic, Eric H. [doi.org]
BU – Amyloid Treatment & Research Program. ↑ Hammarström P, Wiseman RL, Powers ET, Kelly JW (January 2003). "Prevention of transthyretin amyloid disease by changing protein misfolding energetics". [ipfs.io]
Prognosis
Diagnosis - Hereditary ATTR amyloidosis Prognosis - Hereditary ATTR amyloidosis Not supplied. Treatment - Hereditary ATTR amyloidosis Resources - Hereditary ATTR amyloidosis [checkorphan.org]
Patients with TTR Thr-60-Ala and several other mutations have myocardial thickening similar to that caused by AL amyloidosis, although heart failure is less common and the prognosis is better. [web.archive.org]
The deposits are derived from one of several amyloidogenic precursor proteins, and the prognosis of the disease is determined both by the organ(s) involved and the type of amyloid. [acc.org]
Cardiac complications (dysrhythmias and conduction disturbances, cardiomyopathy and dysautonomia) indicate a poor prognosis, even after liver transplantation. [elsevier.pt]
Diagnosis, prognosis, and therapy of transthyretin amyloidosis. J Am Coll Cardiol. 2015;66(21):2451-66. [ Links ] 23 Roof L, Coker WJ, Lazarchick J, Kang Y. [scielo.br]
Etiology
Familial amyloid polyneuropathy (FAP) is the most common form of inherited amyloidotic polyneuropathy, with clinical and electrophysiologic findings similar to neuropathies with differing etiologies (e.g., diabetes mellitus). [indiana.pure.elsevier.com]
Familial amyloid neuropathy: Unusual etiology in clinical practice. [neurologyindia.com]
Of the total number of explants, 74.2% presented cirrhosis of various etiologies: HCV-63%, alcohol-10.1%, cryptogenic-9.7%, AIH-6.2% and HBV-4.4%. HCC was found in 40.9% of the cirrhotic livers. [tts.org]
Other mutant precursor proteins produced in the liver, such as apolipoprotein I and II, lysozyme and fibrinogen Aα, may be of etiological importance as well. [karger.com]
Noninvasive etiologic diagnosis of cardiac amyloidosis using 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy. [scielo.br]
Epidemiology
Deng, Daniel Cruz & Gabriel Vorobiof Current Oncology Reports (2017) Epidemiology of transthyretin-associated familial amyloid polyneuropathy in the Majorcan area: Son Llàtzer Hospital descriptive study Juan Reinés, Tomás Vera, Mercedes Martín, Hernán [doi.org]
Sousa A, Coelho T, Barros J, Sequeiros J: Genetic epidemiology of familial amyloidotic polyneuropathy (FAP)-type I in Póvoa do Varzim and Vila do Conde (north of Portugal). Am J Med Genet 1995;60:512-521. [karger.com]
Systemic AA amyloidosis: epidemiology, diagnosis, and management. Clin Epidemiol. 2014;6:369-77. [ Links ] 36 Scarpioni R, Ricardi M, Albertazzi V. Secondary amyloidosis in autoinflammatory diseases and the role of inflammation in renal damage. [scielo.br]
A European network approach to defining the epidemiology and management patterns for TTR-FAP. Curr Opin Neurol. 2016. 29 (suppl 1):S000–S000. [Medline]. Phull P, Sanchorawala V, Connors LH, Doros G, Ruberg FL, Berk JL, et al. [emedicine.medscape.com]
Sousa A, Coelho T, Barros J, Sequeiros J : Genetic epidemiology of familial amyloidotic polyneuropathy (FAP)-type I in Povoa do Varzim and Vila do Conde (north of Portugal). Am J Med Genet 1995; 60 : 512–521. 3. [nature.com]
Pathophysiology
Abstract Seven patients with familial amyloid neuropathy (AF amyloidosis) were studied to clarify the pathophysiology of the diarrhea associated with this disorder. [ncbi.nlm.nih.gov]
This raises the possibility that other genetic and environmental factors may be involved in the pathophysiology of this disease. [ceparm.com]
New frontiers and insights in pathophysiology, diagnosis, and management. Texas Heart Inst J. 2005;32(2):178-84. [ Links ] 22 Gertz MA, Benson MD, Dyck PJ, Grogan M, Coelho T, Cruz M, et al. [scielo.br]
Islet amyloid and type 2 diabetes; from molecular misfolding to islet pathophysiology. Biochim Biophys Acta. 2001;1537:179-203. Sanchorawala V, Wright DG, Seldin DC, et al. [rarediseases.org]
Hirschfield Amyloidosis: a clinico-pathophysiological synopsis [4] P. Garcia-Pavia, M.T. Tome-Esteban, C. Rapezzi Amyloidosis. Also a heart disease [5] C. Rapezzi, G. Merlini, C.C. [elsevier.pt]
Prevention
Oral administration of tafamidis meglumine, which prevents misfolding and deposition of mutated TTR, is under evaluation in patients with TTR FAP. [ncbi.nlm.nih.gov]
[…] amyloidosis hATTR amyloidosis is caused by a mutation in the transthyretin (TTR) gene that results in misfolded TTR proteins accumulating as amyloid fibrils in multiple tissues in the body, including the nerves, heart, and gastrointestinal tract. 2,4,5 Prevention [checkorphan.org]
Screening and prevention of colorectal cancer Source: Finnish Medical Society Duodecim This article is freely available only to users in the UK. [evidence.nhs.uk]
Different drugs designed to prevent or alleviate accumulation of TTR amyloid protein (transthyretin amyloidois inhibitors) are currently under investigation. [genedx.com]
Symptomatic improvement and prevention of possible SCD can be achieved in patients with bradyarrhythmias by early pacemaker implantation. [elsevier.pt]