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Systemic amyloidosis from A (AA) to T (ATTR): a review

Journal

JOURNAL OF INTERNAL MEDICINE
Volume 289, Issue 3, Pages 268-292

Publisher

WILEY
DOI: 10.1111/joim.13169

Keywords

amyloidosis; Apo-A; diagnosis; heart failure; mass spectrometry

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Systemic amyloidosis is a rare disorder characterized by protein misfolding and deposition, affecting various organs and often leading to progressive organ failure. Significant advancements have been made in the past decade in terms of diagnostic accuracy, prognosis prediction, and management strategies. Accurate typing of the precursor protein is crucial for determining the appropriate treatment approach.
Systemic amyloidosis is a rare protein misfolding and deposition disorder leading to progressive organ failure. There are over 15 types of systemic amyloidosis, each caused by a different precursor protein which promotes amyloid formation and tissue deposition. Amyloidosis can be acquired or hereditary and can affect various organs, including the heart, kidneys, liver, nerves, gastrointestinal tract, lungs, muscles, skin and soft tissues. Symptoms are usually insidious and nonspecific resulting in diagnostic delay. The field of amyloidosis has seen significant improvements over the past decade in diagnostic accuracy, prognosis prediction and management. The advent of mass spectrometry-based shotgun proteomics has revolutionized amyloid typing and has led to the discovery of new amyloid types. Accurate typing of the precursor protein is of paramount importance as the type dictates a specific management approach. In this article, we review each type of systemic amyloidosis to provide the practitioner with practical tools to improve diagnosis and management of these rare disorders.

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