Apolipoprotein A-IV fibrils: structural diagnosis of mixed cardiac amyloidosis.

Aibara, Shintaro; Kassner, Astrid; Wong, Edmond; Klingel, Karin; Papworth, Monika; Althage, Magnus; Wang, Qing-Dong; Correia, Claudia et al. · Nat Commun · 2025

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Abstract

Cardiac amyloidosis (CA) occurs when misfolded proteins deposit as fibrils in the extracellular space of the heart. The fibrillogenic properties of apolipoprotein A-IV (ApoAIV) have been histologically observed and associated with CA pathogenesis. We report the structure of an ApoAIV amyloid from a patient's heart, which coexist amongst transthyretin (TTR) amyloids. These cases of undetected mixed CA highlight the importance of developing broad-spectrum anti-amyloid treatments to improve outcomes in patients.

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