A genealogical and clinical study of the phenotypical variation within the Swedish transthyretin His88Arg (p. His108Arg) amyloidosis family
2015
In 2005 we reported the first case of
transthyretinHis88Arg (p. His108Arg) amyloidosis, a mutation characterised by
cardiomyopathy. Six additional gene carriers of whom five have clinical symptoms of disease have now been identified in Sweden, and we have been able to identify a possible founder and to characterise the Swedish phenotype of the
transthyretin(TTR) His88Arg mutation.
Genealogicalstudies of church records were used to identify the individuals with the disease and their families. Routine clinical investigations of neurological and heart manifestation of the disease were utilised. We found that
genealogicallyall seven individuals were related and originated from the same region in Sweden. Amyloid deposits were demonstrated in biopsies and the TTR His88Arg mutation was identified in all patients. Patients had a late onset disease (similar to 50 years of age) and all exhibited a severe
amyloid cardiomyopathy. A pronounced peripheral axonal neuropathy was with certainty demonstrated in one patient only, who also was operated for a magnetic resonance confirmed
spinal stenosis, however, without any effect on his neurological symptoms. Five of the patients had
carpal tunnel syndrome. The first reported case is now deceased from cardiac failure. One patient has had a sequential heart and liver transplantation. One gene carrier had no symptoms or findings of disease on latest evaluation at the age of 44. In conclusion: the Swedish TTRHis88Arg patients all have a common Swedish founder.
Cardiomyopathywith heart failure, as well as
carpal tunnel syndromeand
spinal stenosiswere early signs of disease; but peripheral neuropathy was present in one patient before symptoms of
cardiomyopathyso the phenotypical presentation of this mutation is variable.
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