Amyloid Proteins From Medullary Thyroid Cancer and Laryngeal Amyloidosis

Study Overview
=================
Brief Summary
-----------------
Using excess tumour samples that contain amyoid, from patients with Medullary Thyroid Cancer, we aim to determine the structures of ex vivo amyloid fibrils from human tumour tissue samples and compare them with that of existing stock of in vitro formed amyloid fibrils. This will permit the analysis of the effects of gene mutation and post-translational modification on the development of amyloid from a disease state. Amyloid is known to accumulate in the brain tissue of patients with neuro-degenerative conditions such as Alzheimer's disease and Dementia. Therefore solving the structure of amyloid fibrils may aid the development of future treatments for these conditions.

Detailed Description
-----------------
This is an anonymous, voluntary inclusion, laboratory based, basic science research study. Appropriate patients who meet the inclusion criteria and complete the consent process will be asked to donate a small sample of excess tumour tissue after the completion of their surgical procedure. This tissue will be transferred to the research laboratory in Leeds University for analysis and subject to a variety of investigations and scientific procedures to achieve the study objectives. These include: - amyloid extraction by tissue homogenization and centrifugation as already documented in the literature. - mass spectrometry analysis to identify and characterize the most prominent proteins present in the amyloid deposits and their possible post-translational modifications. - Transmission Electron Microscopy to characterize at the gross features of the extracted amyloid fibrils at low resolution (>20Å). This relatively simple procedure allows for quick characterization of the samples in order to optimize them for Atomic Force Microscopy (AFM) and Cryo-Electron Microscopy (Cryo-EM). - Atomic Force microscopy to characterize helical parameters of the amyloid fibrils needed to calculate the structure from Cryo-EM data. - Cryo-Electron Microscopy to elucidate the structure of the amyloids extracted from tissue affected in each disease

Official Title
-----------------
An ex Vivo Study to Purify Amyloid Fibrils and Solve Their 3D Structures Using Amyloid Proteins From Medullary Thyroid Cancer and Laryngeal Amyloidosis

Conditions
-----------------
Amyloid, Medullary Thyroid Cancer, Alzheimer Disease, Dementia

Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Diagnosed with known or suspected MTC or LA Age >= 18 years, no upper age limit Able to provide informed consent for both surgical treatment and inclusion into this study For MTC patients, treatment recommendation from the Thyroid MDT is for either hemithyroidectomy or total thyroidectomy for LA patients, agreement with their attending clinician to undergo surgical debulking of disease under general anaesthetic. The procedure is called 'microlaryngoscopy and biopsy/debulking' Exclusion Criteria: No known or suspected diagnosis of MTC or LA Age <18 years Unable to provide informed consent Treatment recommendation from Thyroid MDT is for any treatment excluding primary surgery (ie palliation, best supportive care, chemotherapy, radiotherapy etc) For LA patients, no agreement between patient and attending clinician to proceed with surgery as primary treatment.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Group 1<br>Patients diagnosed with medullary thyroid cancer (MTC) who are undergoing standard surgical treatment for their disease. This will be either hemithyroidectomy or total thyroidectomy. Patients with laryngeal amyloidosis (LA) who are undergoing standard surgical treatment of this disease. This will be microlaryngoscopy & biopsy/debulking | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Amyloid extraction by tissue homogenization and centrifugation | A standard laboratory technique for subsequent analysis | 12-24 months | 
| Transmission electron microscopy | To characterize the gross features of the extracted amyloid fibrils at low resolution (>20Å). This relatively simple procedure allows for quick characterization of the samples in order to optimize them for Atomic Force Microscopy (AFM) and Cryo-Electron Microscopy (Cryo-EM). | 12-24 months | 
| Atomic force microscopy | To characterize helical parameters of the amyloid fibrils needed to calculate the structure from Cryo-EM data. | 12-24 months | 
| Cryo-electron microscopy (Cryo-EM) | To elucidate the structure of the amyloids extracted from tissue affected in each disease | 12-24 months | 
| Mass spectrometry | Analysis to identify and characterize the most prominent proteins present in the amyloid deposits and their possible post-translational modifications. | 12-24 months |