Doksycyklina w terapii amyloidozy układowej z zajęciem serca

Abstract

The leading strategy in the management of systemic amyloidosis is currently focused on reducing the production of amyloid precursor proteins. This approach is based on the use of chemotherapy in light chain amyloidosis (AL amyloidosis) or liver transplantation, or attempts to suppress transthyretin gene expression (TTR) in patients with transthyretin amyloidosis (ATTR). Recently, however, therapies have been increasingly developed to reduce the formation of amyloid deposits from circulating precursors or to eliminate already formed amyloid deposits. This approach includes, in particular, the chronic use of doxycycline, a well-known bacteriostatic antibiotic from the tetracycline group. In preclinical studies it was shown that the anti-amyloidogenic potential of doxycycline in AL amyloidosis depends on interference in the process of amyloidogenesis and the destruction of amyloid deposits. Clinical retrospective studies indicate that doxycycline used with standard chemotherapy improves prognosis in patients with AL amyloidosis with heart involvement, which is the most unfavorable prognostic group, while maintaining a favorable safety profile of therapy. In contrast, in ATTR, doxycycline appears to stabilize the clinical course of the disease. In this paper, we review literature on the role of doxycycline therapy in the treatment of systemic amyloidosis.