Amyloidosis

Proteins are long chains of molecules that fold up into a certain shape. The exact shape is critical to how each protein functions. All types of amyloidosis involve a protein that folds abnormally. The abnormally folded proteins clump together and accumulate in various body tissues as amyloid deposits. These deposits are made up of amyloid fibrils, which contain abnormal protein fibers that cannot be easily broken down by the body. These deposits interfere with normal function of the organ where they are located. All of these proteins are produced within the body and do not come from a person's diet. Some amyloid proteins are mutated versions of normal proteins. Others are normal proteins that simply have a tendency to fold abnormally. Some of the proteins are produced in various other diseases (such as tuberculosis Tuberculosis (TB) Tuberculosis is a chronic contagious infection caused by the airborne bacteria Mycobacterium tuberculosis. It usually affects the lungs, but almost any organ can be involved. Tuberculosis... read more or rheumatoid arthritis Rheumatoid Arthritis (RA) Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints.... read more ).

Amyloid deposits may be

The severity of the disease depends on which organs are affected by the amyloid deposits.

The accumulation of large amounts of amyloid deposits can disturb the normal functioning of many organs. Some people have few symptoms, whereas others develop severe, life-threatening disease. Common symptoms of amyloidosis are fatigue and weight loss. Other symptoms of amyloidosis depend on where the amyloid deposits build up.

When the heart is affected, people may have abnormal heart rhythms Overview of Abnormal Heart Rhythms Abnormal heart rhythms (arrhythmias) are sequences of heartbeats that are irregular, too fast, too slow, or conducted via an abnormal electrical pathway through the heart. Heart disorders are... read more or heart failure Heart Failure (HF) Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more , which may cause shortness of breath, weakness, or fainting.

When nerves are affected, people may have tingling or numbness in the fingers or toes or dizziness when standing up. When the kidneys are affected, people may have swelling (edema) of the feet and legs and sometimes the abdomen.

When the skin is involved, easy bruising is common, which can sometimes occur around the eyes. The tongue sometimes enlarges (macroglossia).

Amyloidosis is sometimes difficult for doctors to recognize because it causes so many different problems, and many of these problems are also caused by other diseases. Doctors suspect amyloidosis when people have symptoms involving multiple organs of the body, or if they have unexplained heart, kidney, or liver failure. Macroglossia is not a common symptom, but when it occurs it is suggestive of amyloidosis. When several family members have heart or nerve problems, it may suggest AF amyloidosis. Unexplained heart symptoms in older men is suggestive of ATTRwt amyloidosis.

The diagnosis is generally made by testing a small amount of abdominal fat obtained through a needle inserted in the belly (fat pad biopsy). Alternatively, doctors can do a biopsy by taking a sample of tissue from a part of the body that has been affected by the amyloidosis, such as the heart, kidneys, or liver, and examining it under a microscope with the use of special stains.

After doctors determine the person has amyloidosis, they do other tests to determine the type of amyloidosis and to identify any disorders that may be the cause of the amyloidosis. They also do tests to see what organs have been affected.

Treatment to decrease or control symptoms and complications of amyloidosis can improve quality of life for people with all forms of amyloidosis. Specific treatments to slow or stop amyloid formation can help in certain forms of amyloidosis.

For people with AL amyloidosis, chemotherapy with melphalan, bortezomib, or lenalidomide, sometimes with a peripheral stem cell transplant Stem Cell Transplantation Stem cell transplantation is the removal of stem cells (undifferentiated cells) from a healthy person and their injection into someone who has a serious blood disorder. (See also Overview of... read more , can arrest the disease in the bone marrow, and prevent progression of the amyloid deposits. Radiation therapy can be used in people whose AL amyloidosis is present in only one area (localized disease).

For AA (secondary) amyloidosis, treating the underlying disease can reduce amyloid deposits. For AA amyloidosis caused specifically by familial Mediterranean fever, colchicine is very effective.

For amyloidosis caused by transthyretin protein deposits, medications such as diflunisal and tafamidis can stabilize transthyretin protein (preventing it from forming amyloid fibrils) and thus slow progression of hereditary and wild type transthyretin amyloid disease. Gene therapies that reduce transthyretin production (such as patisiran, inotersen, and vutrisiran) can improve nervous system effects of hereditary disease.

Organ transplants (for example, a kidney or the heart) have extended the lives of some people with organ failure due to amyloidosis.

In familial transthyretin amyloidosis, liver transplantation Liver Transplantation Liver transplantation is the surgical removal of a healthy liver or sometimes a part of a liver from a living person and then its transfer into a person whose liver no longer functions. (See... read more may be used. Liver transplantation can slow progression of the disease because the liver is where the mutant protein is produced. Interestingly, because there is a shortage of donor organs, the liver removed from a person with familial transthyretin amyloidosis is sometimes transplanted into people with a fatal liver disease such as cirrhosis or liver cancer. Such a "domino transplant" is possible because a liver from a person with familial transthyretin amyloidosis is otherwise a normally functioning liver. Although people who receive a liver from a person with familial transthyretin amyloidosis may eventually develop amyloidosis themselves, the transplant can save their lives in the short term.

The prognosis depends on the type of amyloidosis and the organ system that is affected. Involvement of the heart is the most dangerous form and can have a bleak prognosis.