Antibody-Associated Reversal of ATTR Amyloidosis-Related Cardiomyopathy

This correspondence presents three rare cases of spontaneous regression in ATTR amyloidosis–associated cardiomyopathy (ATTR-CM), a progressive and typically irreversible condition caused by myocardial deposition of transthyretin amyloid. The patients aged 68, 76, and 82 exhibited near-normal cardiac structure and function without new therapies. Imaging showed regression of extracellular volume and cardiac remodeling, while histology confirmed absence of typical inflammation, except in one patient with macrophage and giant-cell infiltrates. All three had circulating polyclonal IgG antibodies specific to ATTR amyloid, suggesting a possible immune-mediated mechanism. This observation challenges assumptions about the irreversibility of ATTR-CM and opens inquiry into antibody-associated disease modification.

This correspondence presents three rare cases of spontaneous regression in ATTR amyloidosis–associated cardiomyopathy (ATTR-CM), a progressive and typically irreversible condition caused by myocardial deposition of transthyretin amyloid. The patients aged 68, 76, and 82 exhibited near-normal cardiac structure and function without new therapies. Imaging showed regression of extracellular volume and cardiac remodeling, while histology confirmed absence of typical inflammation, except in one patient with macrophage and giant-cell infiltrates. All three had circulating polyclonal IgG antibodies specific to ATTR amyloid, suggesting a possible immune-mediated mechanism. This observation challenges assumptions about the irreversibility of ATTR-CM and opens inquiry into antibody-associated disease modification.