Complete Reversal of Nephrotic Syndrome Secondary to Amyloidosis with Use of Infliximab in a Patient with Inflammatory Bowel Disease and Ankylosing Spondylitis

Akdoğan, Mehmet Fatih; Gücün, Murat; Denizli, Nazım; Güney, Murat Can; Akdağ, İ̇brahim; Özcan, Tevhide Bilgen; Duranay, Murat

doi:10.3109/0886022x.2011.577543

Cited by 7 publications

(12 citation statements)

References 13 publications

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“…One retrospective study of 42 patients with AA amyloidosis due to various rheumatic diseases found that after five years, 72.7% of those treated with anti-Interleukin 6 receptor (IL-6) agents were in clinical and laboratory remission compared to 40.7% of those on anti-tumour necrosis factor therapy (TNF) [42]. However, several reports have described the good response to anti-TNF therapy, especially in those with inflammatory bowel disease [37, 43]. For those with severe hepatic disease and often in genetic types, the liver transplant can be a viable option [44-45].…”

Section: Reviewmentioning

confidence: 99%

Gastrointestinal Amyloidosis: Review of the Literature

Rowe¹,

Pankow²,

Nehme³

et al. 2017

Cureus

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Gastrointestinal amyloidosis (GIA), a protein deposition disorder, represents a complex common pathway that encompasses multiple etiologies and presentations. It represents a significant diagnostic and treatment challenge. The disease results from the deposition of insoluble extracellular protein fragments that have been rendered resistant to digestion. GIA can be acquired or genetic, and most commonly results from chronic inflammatory disorders (AA amyloidosis), hematologic malignancy (AL amyloidosis), and end-stage renal disease (Beta-2 amyloidosis). The deposition of these abnormal proteins interferes with gastrointestinal tract (GI) organ structure and function, most notably in the liver and small bowel. Presentation from GI involvement includes cirrhotic sequelae, abdominal pain, malabsorption, and GI bleeding. Diagnosis hinges on pathologic examination of affected tissue, with classic green birefringence under polarized light. Abdominal fat pad and rectal mucosal biopsy have been described as sites of higher sensitivity for diagnosis. Serum amyloid P scintigraphy is near 90% sensitive for diagnosis of AA amyloidosis. Patients should be considered for further evaluation to rule out additional organ involvement, notably cardiac and renal. Treatment hinges on an adequate suppression of the predisposing inflammatory disorder, or malignancy, followed by supportive therapy. Prognosis varies depending on the etiology of the disease, with the AL subtype showing worse outcomes, as well as those with hepatic involvement.

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Section: Reviewmentioning

confidence: 99%

Gastrointestinal Amyloidosis: Review of the Literature

Rowe¹,

Pankow²,

Nehme³

et al. 2017

Cureus

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“…In recent years case reports have shown a reduction of proteinuria in patients receiving anti-TGF-β therapy. TNF-α blockade was successfully used to treat nephrotic syndrome in a patient with AA amyloid due to TNF receptor-associated periodic syndrome [112], and complete reversal of nephrotic syndrome secondary to amyloidosis was observed in a patient with inflammatory bowel disease and ankylosing spondylitis after treatment with infliximab (anti-TNF-α antibody) [113]. In a small study with 15 patients with renal amyloidosis, anti-TNF therapy had positive effects on the reduction of proteinuria in some patients [114].…”

Section: Anti-transforming Growth Factor Beta Therapymentioning

confidence: 99%

Podocyte directed therapy of nephrotic syndrome—can we bring the inside out?

Müller-Deile

Schiffer

2015

Pediatr Nephrol

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Several of the drugs currently used for the treatment of glomerular diseases are prescribed for their immunotherapeutic or anti-inflammatory properties, based on the current understanding that glomerular diseases are mediated by immune responses. In recent years our understanding of podocytic signalling pathways and the crucial role of genetic predispositions in the pathology of glomerular diseases has broadened. Delineation of those signalling pathways supports the hypothesis that several of the medications and immunosuppressive agents used to treat glomerular diseases directly target glomerular podocytes. Several central downstream signalling pathways merge into regulatory pathways of the podocytic actin cytoskeleton and its connection to the slit diaphragm. The slit diaphragm and the cytoskeleton of the foot process represent a functional unit. A breakdown of the cytoskeletal backbone of the foot processes leads to internalization of slit diaphragm molecules, and internalization of slit diaphragm components in turn negatively affects cytoskeletal signalling pathways. Podocytes display a remarkable ability to recover from complete effacement and to re-form interdigitating foot processes and intact slit diaphragms after pharmacological intervention. This ability indicates an active insideout signalling machinery which stabilizes integrin complex formations and triggers the recycling of slit diaphragm molecules from intracellular compartments to the cell surface. In this review we summarize current evidence from patient studies and model organisms on the direct impact of immunosuppressive and supportive drugs on podocyte signalling pathways. We highlight new therapeutic targets that may open novel opportunities to enhance and stabilize inside-out pathways in podocytes.

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“…There are several tools for amyloid typing, including immunofluorescence, immunohistochemistry, immunoelectron microscopy, and proteomic studies [14,46]. Unfortunately, amyloid typing was not used in 11 reported cases [3,23–29,32,35,36,38]. We found that AA amyloidosis may be accompanied by other related disorders beside IBD, such as arthropathy or arthritis, which was the most reported disorder [3,22,26,29,34], FMF [3], or other extraintestinal manifestations [3,34].…”

Section: Discussionmentioning

confidence: 99%

“…#1 Crohn's Disease 'Crohn Disease'[Mesh] OR Crohn[tiab] OR Crohns[tiab] OR Crohn's[tiab] 65 650 #2Ulcerative colitis 'colitis, ulcerative'[MeSH Terms] OR ulcerative colitis[Text Word] OR colitis[tiab] OR 'ulcerative colitis'[tiab] 89 040 #3 Inflammatory bowel diseases 'inflammatory bowel diseases'[MeSH Terms] OR 'inflammatory bowel disease'[Text Word] OR 'inflammatory bowel disease'[tiab] 118 237 #4 amyloidosis 'amyloidosis'[MeSH Terms] OR amyloidosis[Text Word] OR 'AA amyloidosis'[tiab] OR 'AA-amyloidosis' [tiab]function[3,22,24,25,[27][28][29]31,34,36,37]; additionally, infliximab contributed to patient stability and prevented the progression of proteinuria or renal injury[3,23,30,34,35]; Unfortunately, infliximab failed in a number of cases, which either led to the progression of proteinuria or renal function[3,26,32,34,36,38].…”

mentioning

confidence: 99%

Therapeutic effects of biological treatments on AA amyloidosis associated with inflammatory bowel disease: a case report and literature review

Alhalabi,

Alaa Eddin,

Abbas

2023

European Journal of Gastroenterology &Amp; Hepatology

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AA amyloidosis is a rare and significant complication of long-term inflammation that can be caused by a variety of disorders, including inflammatory bowel disease, and is linked to an increased risk of morbidity and mortality. To date, there has been no effective direct treatment, and treatment aims at treating the underlying condition with potent immunosuppression to limit inflammatory activity and, as a result, switch off amyloidogenesis. Theoretically, biological treatment can control AA amyloidosis by inducing and maintaining inflammatory bowel disease remission and inhibiting the synthesis of Serum Amyloid A, which is an acute phase reactant and precursor protein of AA amyloidosis that accumulates in the organs. We report the first case of ustekinumab’s therapeutic effect after infliximab’s loss of response in AA amyloidosis associated with Crohn’s disease. We also conducted a literature review of the therapeutic effect of biological treatment on AA amyloidosis.

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Complete Reversal of Nephrotic Syndrome Secondary to Amyloidosis with Use of Infliximab in a Patient with Inflammatory Bowel Disease and Ankylosing Spondylitis

Cited by 7 publications

References 13 publications

Gastrointestinal Amyloidosis: Review of the Literature

Gastrointestinal Amyloidosis: Review of the Literature

Podocyte directed therapy of nephrotic syndrome—can we bring the inside out?

Therapeutic effects of biological treatments on AA amyloidosis associated with inflammatory bowel disease: a case report and literature review

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