Raising Awareness to Support Early Detection and Diagnosis of Transthyretin (TTR) Amyloidosis in Ghana/West Africa from a Public and Health Professionals Trainers and Trainees Perspective

OVERVIEW OF TRANSTHYRETIN (TTR) AMYLOIDOSIS

The Transthyretin Protein

Transthyretin (also known as TTR) in its normal form is a plasma homotetrameric (a protein complex made up of 4 identical subunits as shown in the motion video) protein with a molecular weight of 55 kilo Dalton (kDa), known to transport thyroxine and retinol (vitamin A) via active binding sites. This protein is largely (over 95%) made by the liver, and the choroid plexus of the brain and the retinal pigment epithelium of the eye make the remaining minute quantities. 

Amyloidosis

Amyloidosis is a protein folding disorder into insoluble strands known as Amyloid fibrils made of abnormal proteins called Amyloid proteins and cannot be easily broken down, as is the case for normal proteins in our bodies. Some amyloid proteins are AL, AA, and ATTR. These are convenient naming systems for abnormal proteins, where the prefix “A” stands for Amyloid, followed by an abbreviation of the protein involved. For example, AL is Amyloid derived from light-chained antibodies (L), AA denotes serum amyloid A protein (A), ATTR designates Amyloid from Transthyretin (TTR), and the disease is Transthyretin Amyloidosis (ATTR Amyloidosis). 

The human body makes several proteins that can cause Amyloidosis; however, the two most common types are Amyloid derived from Transthyretin protein (ATTR) and Amyloid derived from light-chained antibodies (AL), with a varied distribution globally. 

Transthyretin Amyloidosis

Transthyretin amyloidosis may be hereditary, a genetic mutation that can be passed to different generations or the result of old age (≥60 years), and factors other than deoxyribonucleic acid (DNA) mutation. ATTR Amyloidosis due to DNA mutation is called Hereditary/Familial Transthyretin Amyloidosis (also known as ATTRv Amyloidosis), and ATTR Amyloidosis due to other factors is referred to as wild-type ATTR Amyloidosis (ATTRwt Amyloidosis). The symptoms of hereditary TTR Amyloidosis begin to show as early as age 20 years, and the wild-type TTR Amyloidosis begins in the ≥60 age group; however, a recent case of ATTRwt Amyloidosis was recorded in a 58-year-old patient in the United Kingdom. Reports of a hereditary TTR Amyloidogenic variant due to mutation in which valine at position 122 is changed to isoleucine (TTR V122I) have shown that the TTR V122I variant has a record average prevalence of 2.5% in 6 West African countries as follows: Burkina Faso, Cote d’Ivoire (Ivory Coast), Ghana, Guinea, Nigeria, and Sierra Leone. 

TRAINING APPROACH

This will take a three-prong approach.

ONE:

The training will employ an in-person train-the-trainer approach for 3 days in Kumasi, including Health workers/Health Professionals from Teaching and Regional/Municipal/District Hospitals in Ghana will be trained through modular training workshops at Ghana's southern and northern zones. The five (5) staff from each of the target Teaching and Regional/Municipal Hospitals will comprise:

• A Medical Officer/Doctor
• A Nurse/Midwife
• A Biomedical Scientist
• A Pharmacist
• A Disease Control Officer

While the medical, biomedical, and public health staff of public Universities in Ghana that have fully operationalized medical schools will include five (5) Staff from the following faculties/schools:

• School of Medicine Clinical Staff
• School of Allied Health Sciences Medical Laboratory Diagnostic
• School of Pharmacy
• School of Nursing and Midwifery
• School of Public Health

Together with health professionals/health scientists known as the Transthyretin Amyloidosis Workforce Network (TAWN) from Burkina Faso, Cote d’Ivoire, Guinea, Nigeria, and Sierra Leone.

TWO:

All other target health professionals (listed below), will be able to access and receive the training on this platform virtually at their convenience. A Certificate of Completion will be awarded, as well as CPD Points, for all registered health professionals since the training is fully accredited by the Medical and Dental Council, the Pharmacy Council, the Allied Health Professions Council, and the Nursing and Midwifery Council.

ADDITIONAL INFORMATION

After such training, the participants will serve as Transthyretin Amyloidosis Support Network (TASN) in Northern and Southern Ghana. The two (2) main TASN networks in Ghana will facilitate awareness creation in hospitals and universities, and TAWN will support the training and establishment of TASN in their respective countries.

The Health Professionals of the TASN will support staff in their respective units to follow the training on a virtual platform and help to assess the needs of their staff and departments to realize the purpose of this training before the training commences. University TASN members will engage the medical, medical laboratory, pharmacy, nursing/midwifery, and public health students and staff in their institutions in anticipation that we will start an Amyloidosis Club (AC) in Ghana/West Africa soon.

THREE:

In addition to the Continuing Professional Development training plan, the public will be reached via T.V./Radio Talk programs, YouTube, Facebook, and WhatsApp to learn about Transthyretin Amyloidosis.

TARGET AUDIENCE

The target audience for the awareness exercise is health professionals/health scientists and health sciences students (medical students, medical laboratory students, pharmacy students, nursing/midwifery students, and public health students).

ORGANIZED BY

IN PARTNERSHIP WITH

WITH TECHNICAL SUPPORT FROM

This will be a hybrid event. In-person attendance will be at True Vine Hotel, Ahodwo-Kumasi, Ashanti Region from Wednesday the 6th to Friday the 8th of September 2023. The CPD event will be streamed LIVE on this page.

IN PERSON ATTENDANCE FULLY SPONSORED LIMITED SPACES AVAILABLE (CONTACT niiamasa@ces.edu.gh)

Date:  6th to 8th September 2023

Time: 0900-1700 GMT each day

The agenda for this event is available and accessible in the downloadables section of this course.