Abstract

Hereditary transthyretin-mediated (hATTR) amyloidosis with polyneuropathy is a rare, inherited, multisystem, and often fatal disease caused by a variant in transthyretin (TTR) gene. Baseline characteristics of patients, especially anthropometric data, are scarce in the literature, and they are relevant to define effective treatment strategies. This study aimed to describe baseline demographic, anthropometric, and disease characteristics in a cohort of patients from a reference center in Brazil. Symptomatic patients not previously included in clinical trials and eligible for treatment were enrolled. Ethnicity, state of residence, age, sex, weight, height, body mass index (BMI), TTR variant, and Polyneuropathy Disability Score (PND) at diagnosis were analyzed. Among the 108 patients enrolled, 58.33% were male, 60.19% were Caucasian, and 83.33% lived in the Southeast region. Mean age was 51.61 (±16.37) years, mean weight was 65.76 (±15.16) kg, mean height was 168.33 (±10.26) cm, and mean BMI was 23.11 (±4.45) kg/m2. The most prevalent variant was V30M (86.11%). Patients with PND score 0 presenting autonomic neuropathy were 14.81%. Patients with PND score I-II and III-IV were 52.78 and 32.41%, respectively. Mean weight and BMI were significantly lower in patients with sensory-motor manifestations. This is the largest cohort of patients in Brazil for whom anthropometric characteristics have been described. Baseline demographic, anthropometric, and disease data indicate that delay in diagnosis of hATTR amyloidosis with polyneuropathy is still a problem and that efforts must be made to expedite diagnosis and maximize opportunities for new disease-modifying treatments.

Highlights

  • Amyloidosis comprises a heterogeneous group of diseases that is fundamentally characterized by the deposit of insoluble amyloid fibril in several tissues and organs, causing progressive and severe multisystem clinical manifestations[1,2,3,4].Transthyretin-mediated (ATTR) amyloidosis is caused by the extracellular deposit of transthyretin (TTR), a soluble tetrameric protein produced mainly in the liver, and in the choroid plexus in the brain and in the retinal pigment epithelium, which carries retinol and thyroxin in blood and cerebrospinal fluid

  • Most of the patients (83.33%) lived in the Southeast region of Brazil and the remaining 16.67% were distributed in all other regions

  • The very low prevalence and the differential diagnosis with more prevalent diseases associated with polyneuropathy are concurrent factors that lead to misdiagnoses, which prolongs the patient’s journey to a definitive diagnosis

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Summary

Introduction

Amyloidosis comprises a heterogeneous group of diseases that is fundamentally characterized by the deposit of insoluble amyloid fibril in several tissues and organs, causing progressive and severe multisystem clinical manifestations[1,2,3,4].Transthyretin-mediated (ATTR) amyloidosis is caused by the extracellular deposit of transthyretin (TTR), a soluble tetrameric protein produced mainly in the liver, and in the choroid plexus in the brain and in the retinal pigment epithelium, which carries retinol and thyroxin in blood and cerebrospinal fluid. Amyloidosis comprises a heterogeneous group of diseases that is fundamentally characterized by the deposit of insoluble amyloid fibril in several tissues and organs, causing progressive and severe multisystem clinical manifestations[1,2,3,4]. The variants influence many aspects of the disease, such as clinical presentation, severity, and overall survival. Some variants, such as V30M, cause mainly neurological manifestations (hATTR amyloidosis with polyneuropathy), while other variants affect mainly the heart (hATTR amyloidosis with cardiomyopathy). Hereditary transthyretin-mediated (hATTR) amyloidosis with polyneuropathy is a rare, inherited, multisystem, and often fatal disease caused by a variant in transthyretin (TTR) gene. Anthropometric, and disease data indicate that delay in diagnosis of hATTR amyloidosis with polyneuropathy is still a problem and that efforts must be made to expedite diagnosis and maximize opportunities for new disease-modifying treatments

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