Clinical approach of patients with systemic amyloidosis
B.P.C. Hazenberg, MD, PhD
Whole body amyloid deposition imaging by 123I-SAP scintigraphy
R.W.J. van Rheenen, MD
Echocardiography and magnetic resonance imaging for the detection of cardiac amyloidosis
M. Groenink, MD, PhD
Nuclear imaging in cardiac amyloidosis: the role of 123I-MIBG
W. Noordzij, MD
Development and evaluation of agents for targeting visceral amyloid
J.S. Wall, PhD
Amyloid Imaging in Alzheimer’s Disease
N. Tolboom, MD, Phd
Amyloid imaging with PET: what will be next?
J. Booij, MD, PhD
COURSES & CONFERENCES
From the editors
Amyloidosis is the name of a group of disorders characterized by deposits of protein fibres (fibrils) in organs and tissues resulting in swelling and dysfunction. If this deposition process is not stopped in the early stages of the disease it can lead to the failure of the affected organ. Because most of the affected organs have a vital function (heart, liver, spleen and kidneys) the failure of these organs can lead to serious complications and even to death. It is therefore of great importance to identify the organs involved at the earliest possible moment. However, amyloidosis is a rare disease (estimated at 8-14 per million per year) and patients with the disease are often treated in specialized institutions (top referral care). This makes that even in a highly trained medical community (i.e. The Netherlands) amyloidosis is a relatively unknown disease.
Until thirty years ago the treatment of amyloidosis had mostly a supportive nature. In recent years however, new systemic therapies were devised and implemented with a relatively high success rate. There are indications that the response to these therapies depends on the number of organs involved. It is therefore eminent to assess which organs and to what extent these organs are involved in the disease. Non-invasive imaging techniques in general and nuclear medicine techniques in particular play a pivotal role in determining the disease and in identifying the extent of the disease. In addition, however to a lesser extent, these imaging techniques play a role in assessing the effectiveness of therapy.
In light of all these exciting developments and innovations, we felt that there was an unmet need to bring you up to date on amyloidosis and what better medium to choose than our own Journal.
To give you a better understanding of amyloidosis we have asked several national and international specialists in the field of amyloidosis to bring you up to date and to give you an idea of the future perspectives. There are contributions by clinicians, researchers and imagers. First, Dr. Hazenberg, rheumatologist and clinical immunologist at the University Medical Center Groningen (UMCG), discusses the diagnostic and therapeutic options in these patients from a clinical perspective. This is followed by a contribution from the UMCG (Drs. van Rheenen and Drs. Glaudemans) focussing on 123I-serum amyloid P (SAP) scintigraphy to assess organ involvement. In a mutual effort from the nuclear medicine departments of the UMCG and the Academic Medical Center (AMC) in Amsterdam (Drs. Noordzij, Dr. Verberne and Dr. Slart), these authors highlight the possibilities of nuclear medicine techniques to assess amyloidosis in a sole organ: the heart. In addition Dr. Groenink (cardiologist) and Dr. Verberne, both from the AMC in Amsterdam, present an overview of non-nuclear medicine techniques to either demonstrate or exclude cardiac amyloidosis.
In contrast to all this amyloidosis deposition, Dr. Tolboom (nuclear medicine physician in training at the VUMC in Amsterdam) discusses the imaging possibilities of another protein deposition disorder, with a specific preference for the brains: Alzheimer’s disease. Despite the promising results with PET tracers to image amyloidosis in the brain Prof. Booij (AMC, Amsterdam) emphasizes on the efforts to image amyloid in the brain with imaging techniques other than PET and to image other protein aggregates than ß-amyloid which may be relevant for the neurodegenerative disorders. Last but not least there is a valuable contribution from Knoxville, USA. In this article Prof. Wall discusses various preclinical research lines. To make full circle Prof. Wall shares the opinion of Prof. Booij that there is a need to focus on the development of new tracers for imaging of amyloidosis.
In case you have been triggered by all this exciting information and you would like to learn more on the latest developments in the field of amyloidosis, there is the opportunity to do so. In the spring of 2012 the “XIIIth International Symposium on Amyloidosis” will be held in Groningen from 6 to10 May 2012. This Symposium with the sub-title “From misfolded proteins to well-designed treatment” is organized by GUARD (Groningen Unit for Amyloidosis Research & Development). More information and the possibility to register to attend this symposium can be found at: www.amyloidosis2012.com.
We hope this special issue of the Journal will give you a better understanding of the disease amyloidosis, the current clinical issues and the (essential) role that nuclear medicine can play in assessing disease severity and therapeutic efficacy.
As guest-editors of this special issue we hope you will enjoy reading and hopefully afterwards will share our enthusiasm on the (future) possibilities for nuclear medicine in amyloidosis.
Nuclear Medicine, UMC Groningen
Nuclear Medicine, AMC Amsterdam