Epigallocatechin-3-gallate tolerability and impact on survival in a cohort of patients with transthyretin-related cardiac amyloidosis. A single-center retrospective study
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Transthyretin-related (ATTR) cardiac amyloidosis is currently lacking a disease-modifying therapy. Despite demonstration of effectiveness in halting amyloid deposition, no study focused on epigallocatechin-3-gallate (EGCG) impact on patient survival. We sought to explore prognostic impact of EGCG in a cohort of lone cardiac ATTR patients. From the Florence Tuscan Regional Amyloid Centre database, we retrospectively selected ATTR patients treated with EGCG (675mg daily dose) for a minimum of 9 months, between March 2013 and December 2016. As a control group, we selected ATTR patients who received guideline-directed medical therapy alone. End point of the study was time to all cause death or cardiac transplantation. Sixty-five patients (30 treatment groups vs. 35 control groups) had a median follow-up of 691 days. There were no differences in baseline characteristics between groups. Five deaths occurred in EGCG group versus eight in control group; one patient underwent effective cardiac transplantation in EGCG group. There was no difference in survival estimates between EGCG and control group (60 ± 15% vs. 61 ± 12%, p = 0.276). EGCG was well tolerated, without major safety concerns. In a real-world cohort of ATTR patients with lone cardiac involvement, EGCG was a safe therapeutic option, but was not associated with survival improvement.
KeywordsEpigallocatechin-3-gallate Transthyretin amyloid Cardiac amyloid Survival
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
Statement of human and animal rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 3.Grogan M, Scott CG, Kyle RA, Zeldenrust SR, Gertz MA, Lin G, Klarich KW, Miller WL, Maleszewski JJ, Dispenzieri A (2016) Natural history of wild-type transthyretin cardiac amyloidosis and risk stratification using a novel staging system. J Am Coll Cardiol 68(10):1014–1020CrossRefPubMedGoogle Scholar
- 6.Maurer MS, Elliott P, Merlini G, Shah SJ, Cruz MW, Flynn A, Gundapaneni B, Hahn C, Riley S, Schwartz J, Sultan MB, Rapezzi C (2017) ATTR-ACT study investigators. Design and rationale of the phase 3 ATTR-ACT clinical trial (Tafamidis in transthyretin cardiomyopathy clinical trial). Circ Heart Fail. https://doi.org/10.1161/CIRCHEARTFAILURE.116.003815
- 12.Ferreira N, Saraiva MJ, Almeida M (2012) Natural polyphenols as modulators of TTR Amyloidogenesis in vitro and in vivo evidences towards therapy. Amyloid 19(S1):39–42Google Scholar
- 13.Kristen AV, Lehrke S, Buss S, Mereles D, Steen H, Ehlermann P, Hardt S, Giannitsis E, Schreiner R, Haberkorn U, Schnabel PA, Linke RP, Rocken C, Wanker EE, Dengler TJ, Altland K, Katus HA (2012) Green tea halts progression of cardiac transthyretin amyloidosis: an observational report. Clin Res Cardiol 101(10):805–813CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Mereles D, Buss SJ, Hardt SE, Hunstein W, Katus HA (2010) Effects of the main green tea polyphenol epigallocatechin-3-gallate on cardiac involvement in patients with AL amyloidosis. Clin Res Cardiol 99:483–490Google Scholar
- 15.Aus dem Siepen F, Buss SJ, Andre F, Seitz S, Giannitsis E, Steen H, Katus HA, Kristen AV (2015) Extracellular remodeling in patients with wild-type amyloidosis consuming epigallocatechin-3-gallate: preliminary results of T1 mapping by cardiac magnetic resonance imaging in a small single center study. Clin Res Cardiol 104(8):640–647Google Scholar
- 16.Aus dem Siepen F, Bauer R, Aurich M, Buss SJ, Steen H, Altland K, Katus HA, Kristen AV (2015) Green tea extract as a treatment for patients with wild-type transthyretin amyloidosis: an observational study. Drug Design Dev Therapy 9 6319–6325Google Scholar
- 19.Gillmore JD, Damy T, Fontana M, Hutchinson M, Lachmann HJ, Martinez-Naharro A, Quarta CC, Rezk T, Whelan CJ, Gonzalez-Lopez E, Lane T, Gilbertson JA, Rowczenio D, Petrie A, Hawkins PN (2017) A new staging system for cardiac transthyretin amyloidosis. Eur Heart J. https://doi.org/10.1093/eurheartj/ehx589 PubMedPubMedCentralCrossRefGoogle Scholar
- 20.Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28(1):1–39.e14Google Scholar
- 22.Cappelli F, Frusconi S, Bergesio F, Grifoni E, Fabbri A, Giuliani C, Falconi S, Bonifacio S, Perfetto F (2016) The Val142Ile transthyretin cardiac amyloidosis: not only an afro American pathogenic variant? A single center Italian experience. J Cardiovasc Med 2016 17(2):122–5.44Google Scholar
- 23.Rapezzi C, Quarta CC, Obici L, Perfetto F, Longhi S, Salvi F, Biagini E, Lorenzini M, Grigioni F, Leone O, Cappelli F, Palladini G, Rimessi P, Ferlini A, Arpesella G, Pinna AD, Merlini G, Perlini S (2013 Feb) Disease profile and differential diagnosis of hereditary transthyretin-related amyloidosis with exclusively cardiac phenotype: an Italian perspective. Eur Heart J 34(7):520–528CrossRefPubMedGoogle Scholar