Browsing by Author "Cruz, M."
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- Guideline of transthyretin-related hereditary amyloidosis for cliniciansPublication . Ando, Y.; Coelho, T.; Berk, J.; Cruz, M.; Ericzon, B.; Ikeda, S.; Lewis, W.; Obici, L.; Planté-Bordeneuve, V.; Rapezzi, C.; Said, G.; Salvi, F.Transthyretin amyloidosis is a progressive and eventually fatal disease primarily characterized by sensory, motor, and autonomic neuropathy and/or cardiomyopathy. Given its phenotypic unpredictability and variability, transthyretin amyloidosis can be difficult to recognize and manage. Misdiagnosis is common, and patients may wait several years before accurate diagnosis, risking additional significant irreversible deterioration. This article aims to help physicians better understand transthyretin amyloidosis—and, specifically, familial amyloidotic polyneuropathy—so they can recognize and manage the disease more easily and discuss it with their patients. We provide guidance on making a definitive diagnosis, explain methods for disease staging and evaluation of disease progression, and discuss symptom mitigation and treatment strategies, including liver transplant and several pharmacyotherapies that have shown promise in clinical trials.
- Long-term effects of tafamidis for the treatment of transthyretin familial amyloid polyneuropathyPublication . Coelho, T.; Maia, L.; Martins-Silva, A.; Cruz, M.; Planté-Bordeneuve, V.; Suhr, O.; Conceição, I.; Schmidt, H.; Trigo, P.; Kelly, J.; Labaudinière, R.; Chan, J.; Packman, J.; Grogan, D.Tafamidis, a transthyretin (TTR) kinetic stabilizer, delayed neuropathic progression in patients with Val30Met TTR familial amyloid polyneuropathy (TTR-FAP) in an 18-month randomized controlled trial (study Fx-005). This 12-month, open-label extension study evaluated the long-term safety, tolerability, and efficacy of tafamidis 20 mg once daily in 86 patients who earlier received blinded treatment with tafamidis or placebo. Efficacy measures included the Neuropathy Impairment Score in the Lower Limbs (NIS-LL), Norfolk Quality of Life-Diabetic Neuropathy total quality of life (TQOL) score, and changes in neurologic function and nutritional status. We quantified the monthly rates of change in efficacy measures, and TTR stabilization, and monitored adverse events (AEs). Patients who continued on tafamidis had stable rates of change in NIS-LL (from 0.08 to 0.11/month; p = 0.60) and TQOL (from -0.03 to 0.25; p = 0.16). In patients switched from placebo, the monthly rate of change in NIS-LL declined (from 0.34 to 0.16/month; p = 0.01), as did TQOL score (from 0.61 to -0.16; p < 0.001). Patients treated with tafamidis for 30 months had 55.9 % greater preservation of neurologic function as measured by the NIS-LL than patients in whom tafamidis was initiated later. Plasma TTR was stabilized in 94.1 % of patients treated with tafamidis for 30 months. AEs were similar between groups; no patients discontinued because of an AE. Long-term tafamidis was well tolerated, with the reduced rate of neurologic deterioration sustained over 30 months. Tafamidis also slowed neurologic impairment in patients previously given placebo, but treatment benefits were greater when tafamidis was begun earlier.
- Neutrophil gelatinase-associated lipocalin in kidney transplantation is an early marker of graft dysfunction and is associated with one-year renal functionPublication . Fonseca, Isabel; Carlos Oliveira, José; Almeida, M.; Cruz, M.; Malho, A.; Martins, La Salete; Dias, L.; Pedroso, S.; Santos, J.; Lobato, L.; Castro-Henriques, A.; Mendonça, D.Urinary neutrophil gelatinase-associated lipocalin (uNGAL) has been suggested as potential early marker of delayed graft function (DGF) following kidney transplantation (KTx). We conducted a prospective study in 40 consecutive KTx recipients to evaluate serial changes of uNGAL within the first week after KTx and assess its performance in predicting DGF (dialysis requirement during initial posttransplant week) and graft function throughout first year. Urine samples were collected on post-KTx days 0, 1, 2, 4, and 7. Linear mixed and multivariable regression models, receiver-operating characteristic (ROC), and areas under ROC curves were used. At all-time points, mean uNGAL levels were significantly higher in patients developing DGF (n = 18). Shortly after KTx (3-6 h), uNGAL values were higher in DGF recipients (on average +242 ng/mL, considering mean dialysis time of 4.1 years) and rose further in following days, contrasting with prompt function recipients. Day-1 uNGAL levels accurately predicted DGF (AUC-ROC = 0.93), with a performance higher than serum creatinine (AUC-ROC = 0.76), and similar to cystatin C (AUC-ROC = 0.95). Multivariable analyses revealed that uNGAL levels at days 4 and 7 were strongly associated with one-year serum creatinine. Urinary NGAL is an early marker of graft injury and is independently associated with dialysis requirement within one week after KTx and one-year graft function.
- NIVEIS DE SUPERÓXIDO DISMUTASE REVELAM STRESS OXIDATIVO AUMENTADO NA POLINEUROPATIA AMILOIDÓTICA FAMILIARPublication . REGUENGO, HENRIQUE; Cardoso, M. L.; Coelho, T.; Martins, A.; Novais, M.; Cruz, M.; Fonseca, Isabel; Martins, B.; Marques, F.NIVEIS DE SUPERÓXIDO DISMUTASE REVELAM STRESS OXIDATIVO AUMENTADO NA POLINEUROPATIA AMILOIDÓTICA FAMILIAR Henrique Reguengo1,2, Maria Luís Cardoso2, Teresa Coelho3, Ana Martins3, Marta Novais3, Madalena Cruz1, Isabel Fonseca3, Berta Martins4, Franklim Marques2 1Serviço de Química Clínica, HSA/CHP, 2FFUP, 3Unidade Clínica de Paramiloidose, HSA/CHP, 4Laboratório de Imunogenética, ICBAS/UP. Hospital de Santo António, Centro Hospitalar do Porto (HSA/CHP), Porto. Faculdade de Farmácia, Universidade do Porto (FF/UP), Porto. Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto (ICBAS/UP), Porto. Introdução A polineuropatia amiloidótica familiar (PAF) é provocada por mutações no gene da transtirretina, principalmente em resultado da mutação TTRv30M no caso de Portugal. Estudos recentes em vários tipos de amiloidoses revelam que o stress oxidativo pode estar envolvido quer na produção das fibrilas de proteína amilóide, quer na modificações pós formação das fibrilas. A enzima superóxido dismutase (SOD) desempenha um importante papel antioxidante que protege as células expostas aos radicais superóxido. O presente estudo pretendeu avaliar o stress oxidativo nesta patologia. Material e Métodos A amostra em estudo incluiu 40 doentes com PAF e 45 portadores assintomáticos da mutação, seguidos habitualmente na Unidade Clínica de Paramiloidose do CHP. Foi ainda considerado um grupo controlo de 26 indivíduos saudáveis. Avaliou-se a concentração de SOD intra-eritocitária com um método colorimétrico disponível no KIT RANSOD ref SD 125 da Randox. A análise estatística foi efectuada utilizando o software SPSS, versão 19. Resultados Os valores de SOD obtidos foram os seguintes: Controlos: (1208±254 U/g Hb), Portadores assintomáticos (1436±62 U/g Hb), Doentes com PAF (1455±350 U/g Hb). Os valores resultaram da média de três réplicas. Os valores de SOD foram significativamente mais elevados no grupo de doentes com PAF e nos portadores assintomáticos, comparativamente ao grupo controlo (respectivamente P=0.003 e P=0.013). Não foram encontradas diferenças estatisticamente significativas entre os doentes com PAF e os portadores assintomáticos. No grupo de doentes com PAF verificou-se uma correlação positiva significativa entre os valores de SOD e Proteína C reactiva (r=0.45, P =0.013). Conclusão A alteração da concentração da SOD nos doentes com PAF sugere uma maior exposição dos mesmos a fenómenos de stress oxidativo comparativamente ao grupo controlo. Dado que este fenómeno pode ter influência quer no despoletar, quer no curso da patologia da doença, justifica-se uma maior atenção e estudo deste fenómeno nestes doentes. Apresentador: Henrique Reguengo, Técnico Superior de Saúde, Serviço de Quimica Clínica, HSA/CHP; Aluno de Doutoramento em Ciências Farmacêuticas, FF/UP.