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Abstract Details

Neurofilament Light Chain (NfL) as a Potential Biomarker in Hereditary Transthyretin-Mediated (hATTR) Amyloidosis
General Neurology
S57 - General Neurology: Diagnostic Testing and Disease Biomarkers (5:18 PM-5:30 PM)
010

Evaluate the impact on circulating protein biomarkers in response to patisiran treatment in patients with hATTR amyloidosis with polyneuropathy.

Hereditary transthyretin-mediated (hATTR) amyloidosis is a rare, rapidly progressing, life-threatening disease caused by deposition of aggregated TTR amyloid in organs and tissues. The majority of patients develop a mixed phenotype that includes polyneuropathy and cardiomyopathy. Since TTR amyloid accumulates over time in nerves and other tissues, it is likely that tissue damage occurs prior to overt symptomology. Clinically validated and non-invasive plasma biomarkers proximal to the neuropathology may facilitate earlier diagnosis and treatment initiation, as well as aid in monitoring disease progression/regression.

Proteomic analysis (by proximity extension) was used to measure 1164 proteins in plasma samples collected from consenting patients in the Phase 3 APOLLO trial who received either placebo or patisiran 0.3 mg/kg IV q3w. A linear mixed model determined the impact of patisiran treatment on the time profile of each protein level at 0, 9, and 18 months.  
66 proteins showed a significant change in levels following patisiran treatment (p<4.18x10-5); change in neurofilament light chain (NfL), a marker of neuronal damage, was most significant (p<10-20). Plasma NfL was significantly reduced with patisiran at 9 and 18 months compared to placebo. Improvement in mNIS+7 at 18 months compared to baseline significantly correlated with reduced NfL levels for the same time interval (R=0.40, p<10-7). 
NfL may serve as a biomarker of nerve damage and polyneuropathy due to TTR amyloid deposition, as seen by the correlation with patisiran and change in mNIS+7. This may offer potential for earlier diagnosis of polyneuropathy in patients with hATTR amyloidosis and monitoring disease progression/regression over time, with or without treatment.
Authors/Disclosures

PRESENTER
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Amy Chan, MD (Dartmouth-Hitchcock Medical Center) Dr. Chan has nothing to disclose.
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