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Familial amyloid polyneuropathy.

David Adams1, Cécile Cauquil, Céline Labeyrie

  • 1aService de Neurologie, CHU Bicêtre, Assistance Publique - Hôpitaux de Paris bNational Reference Center for Familial Amyloid Poyneuropathy, Le Kremlin Bicêtre cINSERM U1195 dUniversité Paris Sud, Orsay eFILNEMUS, Marseille, France.

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Transthyretin familial amyloid polyneuropathy (ATTR-PN) is a disabling condition. This review covers ATTR-PN diagnosis, management, and emerging treatments like TTR gene silencing.

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Area of Science:

  • Neurology
  • Genetics
  • Internal Medicine

Background:

  • Transthyretin familial amyloid polyneuropathy (ATTR-PN) is a disabling adult-onset hereditary polyneuropathy caused by transthyretin gene mutations.
  • ATTR-PN diagnosis and management have advanced, with increasing recognition in non-endemic regions.

Purpose of the Study:

  • To provide an updated review of ATTR-PN, including its natural history, phenotypes, and diagnostic tools.
  • To discuss expert consensus on patient follow-up and current treatment research.

Main Methods:

  • Review of current literature on ATTR-PN.
  • Analysis of diagnostic advancements for small and large fiber involvement.
  • Evaluation of treatment strategies, including liver transplantation and emerging therapies.

Main Results:

  • ATTR-PN diagnosis is facilitated by TTR gene sequencing, with disease often more severe in non-endemic countries.
  • European consensus guidelines for ATTR-PN management have been established.
  • New data support liver transplantation selection criteria and long-term tafamidis efficacy in late-onset patients. TTR gene silencing drugs are in Phase 3 trials.

Conclusions:

  • Ongoing development of novel diagnostic methods, including multimodal small fiber neuropathy evaluation and resonance magnetic neurography.
  • TTR gene silencing therapies are anticipated for clinical availability, representing a significant advancement in ATTR-PN treatment.