Transforming amyloidosis care: a new era of targeted therapies

Dr Vijay Shyam-Sundar
21/01/2025

Take home messages

  • Cardiac amyloidosis is underdiagnosed and can lead to debilitating heart failure and poor survival.
  • Vutrisiran, a gene silencing treatment, was shown in the HELIOS-B trial to significantly reduce the risk of death and recurrent cardiovascular events in patients with transthyretin cardiac amyloidosis.
  • Gene editing holds promise as a treatment option for cardiac amyloidosis.
  • Future therapy may combine gene silencers with amyloid-fibril clearing agents such as monoclonal antibodies.

Transthyretin (ATTR) amyloidosis is a systemic disorder particularly affecting the heart and nerves resulting from the misfolding and aggregation of transthyretin (TTR) protein into amyloid fibrils. Cardiac amyloidosis can lead to debilitating heart failure, arrhythmias, and poor survival, with a median life expectancy of 2–6 years following diagnosis (1). Although TTR stabilisers like tafamidis have been demonstrated to slow disease progression, emerging gene-silencing therapies are revolutionising the treatment landscape (2,3) . These therapies target TTR protein production at the genetic level, providing more potent disease modification. The recently completed HELIOS-B trial highlights the efficacy of a gene silencer, vutrisiran, in ATTR amyloidosis and cardiomyopathy, advancing hopes for improved outcomes in this challenging condition (4).