Evidence map›Paper›PMID 41226753›Full record

ArticleInternational journal of molecular sciences2025

Profibrotic Biomarkers Correlate with Clinical Presentation and Outcome in Cardiac Transthyretin Amyloidosis.

Selina J Hein, Fabian Aus dem Siepen, Arnt V Kristen, Stefan Schönland, Ute Hegenbart, Katrin Rein, Hugo A Katus, Norbert Frey, Jennifer Furkel, Mathias H Konstandin and 1 more

Abstract read
In one paragraph

Article in International journal of molecular sciences, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Review
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Selina J HeinDepartment of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, 69120 Heidelberg, Germany.ORCID 0000-0003-0139-4200
Fabian Aus dem SiepenDepartment of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, 69120 Heidelberg, Germany.ORCID 0000-0003-4264-1722
Arnt V KristenDepartment of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, 69120 Heidelberg, Germany.ORCID 0000-0001-7657-3700
Stefan SchönlandDepartment of Hematology, Oncology and Rheumatology, Heidelberg University, 69120 Heidelberg, Germany.ORCID 0000-0002-4853-5579
Ute HegenbartDepartment of Hematology, Oncology and Rheumatology, Heidelberg University, 69120 Heidelberg, Germany.ORCID 0000-0003-1917-6746
Katrin ReinDepartment of Radiation Oncology, German Cancer Research Center (DKFZ) and Heidelberg University Hospital (UKHD), Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany.
Hugo A KatusDepartment of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, 69120 Heidelberg, Germany.ORCID 0000-0002-2293-2314
Norbert FreyDepartment of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, 69120 Heidelberg, Germany.ORCID 0000-0001-7611-378X
Jennifer FurkelDepartment of Radiation Oncology, German Cancer Research Center (DKFZ) and Heidelberg University Hospital (UKHD), Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany.ORCID 0000-0002-1964-4098
Mathias H KonstandinDepartment of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, 69120 Heidelberg, Germany.ORCID 0000-0001-9852-1039
Maximilian KnollDepartment of Radiation Oncology, German Cancer Research Center (DKFZ) and Heidelberg University Hospital (UKHD), Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany.ORCID 0000-0002-9037-3980

Funding

Alnylam Pharmaceuticals® Grant, No. PO 4510001138
6 · The paper itself

Abstract

In transthyretin cardiac amyloidosis (ATTR-CA), misfolded transthyretin accumulates in the myocardium, leading to wall thickening and interstitial fibrosis. Recently published in vitro studies revealed direct effects of transthyretin on the structure, function, and gene expression of cardiac fibroblasts. Therefore, we hypothesized that biomarkers known to modulate myocardial remodeling might be clinically valuable in ATTR-CA and may improve risk stratification in ATTR-CA. To analyze this hypothesis, we evaluated 14 fibrosis-related biomarkers (EN-RAGE, IGFBP-1, -2, -3, -4, -6, FGF-23, MMP-2, -7, -9, -13, TIMP-2, -4, and RAGE-AGE) in 125 patients using Luminex multiplex assays. The study cohort consists of 14 asymptomatic gene carriers (ATTRv-asymp), 47 symptomatic hereditary (ATTRv-CA), 43 wild-type Transthyretin amyloidosis (ATTRwt) patients, and 21 were healthy controls (ctrl). Associations of fibrotic biomarkers and clinical routine data with clinical outcomes-cardiac decompensation (DMP) and transplantation/death (HTX)-were assessed via hierarchical cluster analysis, regression, and prediction modeling. We found that ATTR-CA patients showed distinct biomarker profiles compared to controls. Several markers (e.g., MMP-7, RAGE-AGE, IGFBP-1, FGF-23, TIMP-2) were significantly associated with both endpoints. Cluster analysis identified a high-risk phenotype (Cluster 2) with worse renal function, greater myocardial thickening, and elevated NT-proBNP, hsTNT. Prediction modeling revealed IGFPB-1, -3, -4 and -6 as well as FGF-23, TIMP-2, and RAGE/AGE as the best predictive parameters for cluster assignment. Taken together, these findings confirm our hypothesis that fibrosis-related biomarkers are associated with adverse outcomes in ATTR-CM. Profibrotic mediators such as IGFBP-1, FGF-23, and TIMP-2 may, therefore, provide additional prognostic information beyond established cardiac biomarkers and may reflect underlying fibrotic remodeling pathways.

Indexed as

Amyloid Neuropathies, FamilialBiomarkersCardiomyopathiesAdultAgedFemaleFibroblast Growth Factor-23FibrosisHumansMaleMiddle AgedMyocardiumPrealbuminPrognosisBiomarkersFGF23 protein, humanFibroblast Growth Factor-23Prealbumincardiac transthyretin amyloidosisfibrosisoutcomeremodelingrisk prediction

Identifiers

PMID41226753
PMCPMC12609947

What Socratic holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.