for all blood relatives of patients who undergo full single gene sequencing, multigene panel testing or exome sequencing at Ambry Genetics and are found to have a pathogenic or likely pathogenic variant. No-cost testing of blood relatives must be completed within 90 days of the original report date. Whenever possible, more closely related relatives should be tested before more distant relatives.
Order NowAmyloid deposits found in biopsy specimens, in combination with identification of a pathogenic variant in TTR, are necessary to establish the diagnosis.1 Genetic testing is useful for diagnostic confirmation in symptomatic individuals and for testing of at-risk asymptomatic family members (including prenatal diagnosis). Molecular confirmation of a diagnosis may help avoid unnecessary testing and procedures, guide recommendations for medical treatment and screening, and offer accurate genetic counseling (including risk assessment) for a family.
Genetic testing may be considered for any of the following:
Our familial TTR amyloidosis genetic testing can detect >99% of affected individuals (clinical sensitivity) and can detect >99.9% of described sequencing mutations, when present (analytic sensitivity).
Our familial TTR amyloidosis genetic testing includes next generation sequencing (NGS) and deletion/duplication analysis of the TTR gene. Genomic deoxyribonucleic acid (gDNA) is isolated from the patient’s specimen using a standardized kit and quantified. Sequence enrichment of the targeted coding exons and adjacent intronic nucleotides is carried out by a bait-capture methodology using long biotinylated oligonucleotide probes, followed by polymerase chain reaction (PCR) and NGS.
Sanger sequencing is performed for any regions missing, or with insufficient read depth coverage for reliable heterozygous variant detection. Potentially homozygous variants, variants in regions complicated by pseudogene interference, and variant calls not satisfying depth of coverage and variant allele frequency quality thresholds are verified by Sanger sequencing. This assay targets all coding domains, and well into the flanking 5’ and 3’ ends of all the introns and untranslated regions. Gross deletion/duplication analysis is performed using read-depth from NGS data. Any copy number changes detected by NGS are confirmed by targeted chromosomal microarray or MLPA.