Transthyretin-related Familial Amyloid Polyneuropathy: A Case Report
DOI:
https://doi.org/10.3889/oamjms.2024.11956Keywords:
Hereditary ATTR amyloidosis, heterozygous mutations, TTR gene, case reportAbstract
BACKGROUND: Hereditary amyloidosis transthyretin is an autosomal dominant disease caused by heterozygous mutations in the transthyretin gene. The disease is characterized by amyloid deposits in various organs, primarily in the peripheral nerves and the myocardium.
CASE PRESENTATION: A 53-year-old female patient with the onset of symptoms 2 years earlier, presented with fatigue, difficulty walking, progressive muscle weakness, tingling in the hands and feet, blood pressure variations, weight loss, and constipation. There was no positive family history of familial amyloid polyneuropathy (FAP). Electromyography revealed sensorimotor axonal neuropathy; electrophoresis of cerebrospinal fluid was of transudative type, without immune activity in the central nervous system, while echocardiography detects hypertrophic myocardium and interventricular septum.
CONCLUSION: All patients who show symptoms of peripheral neuropathy with predominant signs of autonomic nervous system damage and hypertrophic cardiomyopathy should be referred for genetic testing for FAP.
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Planté-Bordeneuve V, Said G. Familial amyloid polyneuropathy. Lancet Neurol. 2011;10(12):1086-97. https://doi.org/10.1016/ S1474-4422(11)70246-0 PMid:22094129 DOI: https://doi.org/10.1016/S1474-4422(11)70246-0
Adams D, Beaudonnet G, Adam C, Lacroix C, Théaudin M, Cauquil C, et al. Familial amyloid polyneuropathy: When does it stop to be asymptomatic and need a treatment?. Rev Neurol. 2016;172(10):645-52. https://doi.org/10.1016/j.neurol.2016.08.007 PMid:27663057 DOI: https://doi.org/10.1016/j.neurol.2016.08.007
Nuvolone M, Obici L, Merlini G. Transthyretin-associated familial amyloid polyneuropathy-current and emerging therapies. US Neurol. 2012;8:24-32. https://doi.org/10.5167/uzh-69213 DOI: https://doi.org/10.17925/USN.2012.08.01.24
Escolano-Lozano F, Barreiros AP, Birklein F, Geber C. Transthyretin familial amyloid polyneuropathy (TTR-FAP): Parameters for early diagnosis. Brain Behav. 2018;8(1):e00889. https://doi.org/10.1002/brb3.889 PMid:29568686 DOI: https://doi.org/10.1002/brb3.889
Ando Y, Nakamura M, Araki S. Transthyretin-related familial amyloidotic polyneuropathy. Arch Neurol. 2005;62(7):1057-62. https://doi.org/10.1001/archneur.62.7.1057 PMid:16009758 DOI: https://doi.org/10.1001/archneur.62.7.1057
Shrestha S, Munakomi S. Gower sign. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2024. Available from: https:// www.ncbi.nlm.nih.gov/books/NBK540973 [Last accessed on 2023 Feb 13].
Dugo K, Bruno F, Sturiale V, Brancato D, Saccone S, Federico C. Hereditary transthyretin-related amyloidosis: Genetic heterogeneity and early personalized gene therapy. Biomedicines. 2022;10(10):2394. https://doi.org/10.3390/biomedicines10102394 PMid:36289657 DOI: https://doi.org/10.3390/biomedicines10102394
Takei YI, Ikeda SI, Ikegami T, Hashikura Y, Miyagawa SI, Ando Y. Ten years of experience with liver transplantation for familial amyloid polyneuropathy in Japan: Outcomes of living donor liver transplantations. Intern Med. 2005;44(11):1151-6. https://doi.org/10.2169/internalmedicine.44.1151 PMid:16357452 DOI: https://doi.org/10.2169/internalmedicine.44.1151
Parman Y, Adams D, Obici L, Galán L, Guergueltcheva V, Suhr OB, et al. Sixty years of transthyretin familial amyloid polyneuropathy (TTR-FAP) in Europe: Where are we now? A European network approach to defining the epidemiology and management patterns for TTR-FAP. Curr Opin Neurol. 2016;29(Suppl 1):S3-13. https://doi.org/10.1097/WCO.0000000000000288 PMid:26734951 DOI: https://doi.org/10.1097/WCO.0000000000000288
Obi CA, Mostertz WC, Griffin JM, Judge DP. ATTR epidemiology, genetics, and prognostic factors. Methodist Debakey Cardiovasc J. 2022;18(2):17-26. https://doi.org/10.14797/mdcvj.1066 PMid:35414855 DOI: https://doi.org/10.14797/mdcvj.1066
Conceição I, González-Duarte A, Obici L, Schmidt HH, Simoneau D, Ong ML, et al. “Red-flag” symptom clusters in transthyretin familial amyloid polyneuropathy. J Peripher Nerv Syst. 2016;21(1):5-9. https://doi.org/10.1111/jns.12153 PMid:26663427 DOI: https://doi.org/10.1111/jns.12153
Planté-Bordeneuve V, Gorram F, Salhi H, Nordine T, Ayache SS, Le Corvoisier P, et al. Long-term treatment of transthyretin familial amyloid polyneuropathy with tafamidis: A clinical and neurophysiological study. J Neurol. 2017;264:268-76. https://doi./org/10.1007/s00415-016-8337-3 PMid:27878441 DOI: https://doi.org/10.1007/s00415-016-8337-3
Scott LJ. Tafamidis: A review of its use in familial amyloid polyneuropathy. Drugs. 2014;74(12):1371-8. https://doi.org/10.1007/s40265-014-0260-2 PMid:25022953 DOI: https://doi.org/10.1007/s40265-014-0260-2
Adams D, Suhr OB, Hund E, Obici L, Tournev I, Campistol JM, et al. First European consensus for diagnosis, management, and treatment of transthyretin familial amyloid polyneuropathy. Curr Opin Neurol. 2016;29(Suppl 1):S14-26. https://doi.org/10.1097/WCO.0000000000000289 PMid:26734952 DOI: https://doi.org/10.1097/WCO.0000000000000289
Merlini G, Coelho T, Waddington Cruz M, Li H, Stewart M, Ebede B. Evaluation of mortality during long-term treatment with tafamidis for transthyretin amyloidosis with polyneuropathy: Clinical trial results up to 8.5 years. Neurol Ther. 2020;9(1):105- 15. https://doi.org/10.1007/s40120-020-00180-w PMid:32107748 DOI: https://doi.org/10.1007/s40120-020-00180-w
Adams D, Gonzalez-Duarte A, O’Riordan WD, Yang CC, Ueda M, Kristen AV, et al. Patisiran, an RNAi therapeutic, for hereditary transthyretin amyloidosis. N Engl J Med. 2018;379(1):11-21. https://doi.org/10.1056/NEJMoa1716153 PMid:29972753 DOI: https://doi.org/10.1056/NEJMoa1716153
Michalon A, Hagenbuch A, Huy C, Varela E, Combaluzier B, Damy T, et al. A human antibody selective for transthyretin amyloid removes cardiac amyloid through phagocytic immune cells. Nat Commun. 2021;12(1):3142. https://doi.org/10.1038/s41467-021-23274-x PMid:34035264 DOI: https://doi.org/10.1038/s41467-021-23274-x
Tschöpe C, Elsanhoury A. Treatment of transthyretin amyloid cardiomyopathy: The current options, the future, and the challenges. J Clin Med. 2022;11(8):2148. https://doi.org/10.3390/jcm11082148 PMid:35456241 DOI: https://doi.org/10.3390/jcm11082148
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