Transthyretin amyloidosis is a slowly progressive condition characterized by the buildup of abnormal deposits of a protein called amyloid (amyloidosis) in the body's organs and tissues. Transthyretin amyloidosis (ATTR) is caused by a protein called transthyretin, or TTR, that changes its shape and forms into fibrous clumps. These clumps of misshapen protein are deposited into various organs and peripheral nerves, which can cause them to function abnormally. Two main types of transthyretin amyloidosis are hereditary transthyretin amyloidosis and wild type transthyretin amyloidosis. Hereditary transthyretin amyloidosis (hATTR) is further classified into familial amyloid polyneuropathy (FAP), and familial amyloid cardiomyopathy (FAC). Whereas, wild type variant (ATTRwt) predominantly affects the heart. Transthyretin amyloidosis results from transthyretin produced by the liver, which forms dimers and then monomers. These monomers aggregate to form amyloid fibrils, which get deposited in multiple organs such as heart, nervous system, gastrointestinal tract, and kidneys.
Familial amyloid polyneuropathy (FAP) is a subtype of hereditary transthyretin amyloidosis (hATTR), and the most common type of FAP is caused by the Val30Met variant of TTR. In familial amyloid polyneuropathy, the symptoms are first detected after the patient crosses 30 years of age, however, it can also be detected as early as 20 years or as late as 80 years of age. Symptoms are divided depending on the location such as peripheral neuropathy and autonomic neuropathy. Symptoms may worsen in case excess amyloid protein starts to collect in the nerves.
Market Dynamics
Increasing approval of drugs in pipeline is expected to drive the market, owing to rapid uptake of approved therapies. Various other drugs in the pipeline besides Patisiran and Inotersen, such as Tafamidis and ALN-TTRsc02 are expected to boost growth of the market in the near future. Patisiran had received U.S. FDA approval and is successfully running in the market.
Moreover, in August 2018, the U.S. Food and Drug Administration approved Onpattro (patisiran) infusion for the treatment of peripheral nerve disease (polyneuropathy) caused by hereditary transthyretin-mediated amyloidosis (hATTR) in adult patients. This is the first FDA-approved treatment for patients with polyneuropathy caused by hATTR, a rare, debilitating and often fatal genetic disease characterized by the buildup of abnormal amyloid protein in peripheral nerves, the heart, and other organs. It is also the first FDA approval of a new class of drugs called small interfering ribonucleic acid (siRNA) treatment.
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