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Rombach SM, van den Bogaard B, de Groot E, Groener JEM, Poorthuis BJ, Linthorst GE, van den Born BJH, Hollak CEM, Aerts JMFG. Vascular aspects of Fabry disease in relation to clinical manifestations and elevations in plasma globotriaosylsphingosine. Hypertension 2012; 60:998-1005. [PMID: 22868390 DOI: 10.1161/hypertensionaha.112.195685] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Fabry disease is an X-linked hereditary lysosomal storage disorder attributed to a deficiency of α-galactosidase A leading to increased plasma levels of globotriaosylsphingosine (lysoGb3). The disease presents as a vascular disease, with cerebral, cardiac, and renal complications. Carotid intima-media thickness (IMT), brachial flow-mediated dilation (FMD), pulse wave velocity, and advanced glycation end products were measured in 57 classically affected patients (22 men and 35 women), 55 healthy matched controls (20 men and 35 women), and 10 atypical Fabry disease patients (5 men and 5 women). Most patients received enzyme replacement therapy. In classically affected male patients, brachial FMD was decreased (2.9% [95% CI, 0.8% to 7.9%] versus 5.9% [2.1% to 8.5%] in controls; P=0.01), and carotid IMT was increased (0.67 mm [95% CI, 0.50-0.96 mm] versus 0.59 mm [95% CI, 0.40-0.76 mm] in controls; P=0.01). In women and atypical patients these vascular parameters were comparable with controls. Pulse wave velocity was not different; advanced glycation end products were only slightly increased in atypical patients. In classically affected women, a small increase in lysoGb3 was associated with an increase in IMT independent of age. In the classically affected men, all with increased IMT and high levels of plasma lysoGb3, lysoGb3 levels did not add to a higher IMT, suggestive of a ceiling effect. For FMD, elevated lysoGb3 levels (>7 nmol/L) contributed to a 2.9% lower FMD independent of age and sex (P=0.02). Increased carotid IMT and decreased brachial FMD occur in classic Fabry disease, which is associated with plasma lysoGb3 level independent of age and sex. These observations still exist despite enzyme replacement therapy.
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Affiliation(s)
- Saskia M Rombach
- Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
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Globotriaosylsphingosine accumulation and not alpha-galactosidase-A deficiency causes endothelial dysfunction in Fabry disease. PLoS One 2012; 7:e36373. [PMID: 22558451 PMCID: PMC3340376 DOI: 10.1371/journal.pone.0036373] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 03/30/2012] [Indexed: 12/03/2022] Open
Abstract
Background Fabry disease (FD) is caused by a deficiency of the lysosomal enzyme alpha-galactosidase A (GLA) resulting in the accumulation of globotriaosylsphingosine (Gb3) in a variety of tissues. While GLA deficiency was always considered as the fulcrum of the disease, recent attention shifted towards studying the mechanisms through which Gb3 accumulation in vascular cells leads to endothelial dysfunction and eventually multiorgan failure. In addition to the well-described macrovascular disease, FD is also characterized by abnormalities of microvascular function, which have been demonstrated by measurements of myocardial blood flow and coronary flow reserve. To date, the relative importance of Gb3 accumulation versus GLA deficiency in causing endothelial dysfunction is not fully understood; furthermore, its differential effects on cardiac micro- and macrovascular endothelial cells are not known. Methods and Results In order to assess the effects of Gb3 accumulation versus GLA deficiency, human macro- and microvascular cardiac endothelial cells (ECs) were incubated with Gb3 or silenced by siRNA to GLA. Gb3 loading caused deregulation of several key endothelial pathways such as eNOS, iNOS, COX-1 and COX-2, while GLA silencing showed no effects. Cardiac microvascular ECs showed a greater susceptibility to Gb3 loading as compared to macrovascular ECs. Conclusions Deregulation of key endothelial pathways as observed in FD vasculopathy is likely caused by intracellular Gb3 accumulation rather than deficiency of GLA. Human microvascular ECs, as opposed to macrovascular ECs, seem to be affected earlier and more severely by Gb3 accumulation and this notion may prove fundamental for future progresses in early diagnosis and management of FD patients.
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Chimenti C, Padua L, Pazzaglia C, Morgante E, Centurion C, Antuzzi D, Russo MA, Frustaci A. Cardiac and skeletal myopathy in Fabry disease: a clinicopathologic correlative study. Hum Pathol 2012; 43:1444-52. [PMID: 22406371 PMCID: PMC3423632 DOI: 10.1016/j.humpath.2011.09.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 09/20/2011] [Accepted: 09/22/2011] [Indexed: 11/26/2022]
Abstract
Skeletal muscle disturbances are commonly reported in patients with Fabry disease. Whether they derive from cardiac dysfunction or direct muscle involvement is still unclear. Clinical, noninvasive, and invasive cardiac and muscle studies, including an endomyocardial and muscle biopsy, were obtained in 12 patients (mean age, 42.1 ± 12.6 years; range, 24-58 years) with Fabry disease. In the youngest patients (group A, 4 men aged <35 years), results of cardiac and skeletal noninvasive studies were normal, except for reduced velocities in tissue Doppler imaging. Histologic examination indicated that muscle myocytes were unaffected, whereas muscle vessels showed the presence of mild glycosphingolipid accumulation in endothelial and smooth muscle cells. In the heart, cardiomyocytes and endothelial and smooth muscle cells of intramural cardiac vessels were involved by the disease. The oldest patients (group B, 6 men and 2 women aged >35 years) showed ultrasound muscle disarray and electromyography signs of myopathy, increased left ventricular mass, and normal cardiac function. Histologic examination showed that muscle myocytes contained mild glycosphingolipid accumulation compared with severe engulfment of cardiomyocytes. Moreover, similar infiltration of myocardial and muscle intramural vessels, causing lumen narrowing and fibrofatty tissue replacement, was observed. Direct muscle involvement occurs in patients with Fabry disease. It is milder and delayed compared with that in the heart. The difference in organ function and the need of residual α-galactosidase A activity are the likely causes.
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Affiliation(s)
- Cristina Chimenti
- Cardiovascular, Respiratory, Nefrologic and Geriatric Sciences Department, La Sapienza University, 00100 Rome, Italy
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Uçeyler N, He L, Kahn AK, Breunig F, Müllges W, Sommer C. Cerebral blood flow in patients with Fabry disease as measured by Doppler sonography is not different from that in healthy individuals and is unaffected by treatment. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:463-468. [PMID: 22368137 DOI: 10.7863/jum.2012.31.3.463] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate cervical and cerebral blood flow characteristics in patients with Fabry disease at baseline and under enzyme replacement therapy. METHODS In this case-control study we prospectively studied 68 patients with Fabry disease with extracranial and transcranial Doppler sonography. We compared extracranial and transcranial cervical and cerebral blood flow properties in all patients with Fabry disease and in subgroups of those with or without enzyme replacement therapy, male and female, and with normal or impaired renal function. Eight male patients were investigated at baseline and 1 year after initiation of enzyme replacement therapy. RESULTS We show that cervical and cerebral blood flow parameters in patients with Fabry disease are not different from normal values regardless of sex, renal function, or enzyme replacement therapy. CONCLUSIONS Cervical and cerebral blood flow measured with extracranial and transcranial Doppler sonography is not altered in patients with Fabry disease. Enzyme replacement therapy does not change blood flow characteristics.
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Affiliation(s)
- Nurcan Uçeyler
- Department of Neurology, University of Würzburg, Josef-Schneider-Strasse 11, 97080 Würzburg, Germany.
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Aerts JMFG, Kallemeijn WW, Wegdam W, Joao Ferraz M, van Breemen MJ, Dekker N, Kramer G, Poorthuis BJ, Groener JEM, Cox-Brinkman J, Rombach SM, Hollak CEM, Linthorst GE, Witte MD, Gold H, van der Marel GA, Overkleeft HS, Boot RG. Biomarkers in the diagnosis of lysosomal storage disorders: proteins, lipids, and inhibodies. J Inherit Metab Dis 2011; 34:605-19. [PMID: 21445610 PMCID: PMC3109260 DOI: 10.1007/s10545-011-9308-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 01/21/2011] [Accepted: 02/17/2011] [Indexed: 12/23/2022]
Abstract
A biomarker is an analyte indicating the presence of a biological process linked to the clinical manifestations and outcome of a particular disease. In the case of lysosomal storage disorders (LSDs), primary and secondary accumulating metabolites or proteins specifically secreted by storage cells are good candidates for biomarkers. Clinical applications of biomarkers are found in improved diagnosis, monitoring disease progression, and assessing therapeutic correction. These are illustrated by reviewing the discovery and use of biomarkers for Gaucher disease and Fabry disease. In addition, recently developed chemical tools allowing specific visualization of enzymatically active lysosomal glucocerebrosidase are described. Such probes, coined inhibodies, offer entirely new possibilities for more sophisticated molecular diagnosis, enzyme replacement therapy monitoring, and fundamental research.
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Affiliation(s)
- Johannes M F G Aerts
- Sphinx-Amsterdam Lysosome Center, Departments of Medical Biochemistry and Internal Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
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Myocardial Alterations in the Murine Model of Fabry Disease Can Be Reversed by Enzyme Replacement Therapy. Can J Cardiol 2011; 27:339-45. [DOI: 10.1016/j.cjca.2010.12.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 09/28/2010] [Indexed: 11/21/2022] Open
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Collin C, Briet M, Tran TC, Beaussier H, Benistan K, Bensalah M, Mousseaux E, Froissart M, Bozec E, Laurent S, Boutouyrie P, Germain DP. Long-term changes in arterial structure and function and left ventricular geometry after enzyme replacement therapy in patients affected with Fabry disease. Eur J Prev Cardiol 2011; 19:43-54. [DOI: 10.1177/1741826710391118] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Cédric Collin
- University of Versailles – Saint Quentin en Yvelines (UVSQ), Division of Medical Genetics, Hôpital Raymond Poincaré (AP-HP), Garches, France
- University Paris Descartes, Assistance Publique – Hôpitaux de Paris, INSERM U970, Hôpital Européen Georges Pompidou, Department of Pharmacology, Paris, F-75015 France
| | - Marie Briet
- University Paris Descartes, Assistance Publique – Hôpitaux de Paris, INSERM U970, Hôpital Européen Georges Pompidou, Department of Pharmacology, Paris, F-75015 France
| | - Thi-Chien Tran
- University of Versailles – Saint Quentin en Yvelines (UVSQ), Division of Medical Genetics, Hôpital Raymond Poincaré (AP-HP), Garches, France
- University Paris Descartes, Assistance Publique – Hôpitaux de Paris, INSERM U970, Hôpital Européen Georges Pompidou, Department of Pharmacology, Paris, F-75015 France
| | - Hélène Beaussier
- University Paris Descartes, Assistance Publique – Hôpitaux de Paris, INSERM U970, Hôpital Européen Georges Pompidou, Department of Pharmacology, Paris, F-75015 France
| | - Karelle Benistan
- University of Versailles – Saint Quentin en Yvelines (UVSQ), Division of Medical Genetics, Hôpital Raymond Poincaré (AP-HP), Garches, France
| | - Mourad Bensalah
- Assistance Publique – Hôpitaux de Paris, INSERM U678, Hôpital Européen Georges Pompidou, Department of Radiology, Paris, F-75015 France
| | - Elie Mousseaux
- Assistance Publique – Hôpitaux de Paris, INSERM U678, Hôpital Européen Georges Pompidou, Department of Radiology, Paris, F-75015 France
| | - Marc Froissart
- Assistance Publique – Hôpitaux de Paris, INSERM U1018, Hôpital Européen Georges Pompidou, Department of Physiology, Paris, F-75015 France
| | - Erwan Bozec
- University Paris Descartes, Assistance Publique – Hôpitaux de Paris, INSERM U970, Hôpital Européen Georges Pompidou, Department of Pharmacology, Paris, F-75015 France
| | - Stéphane Laurent
- University Paris Descartes, Assistance Publique – Hôpitaux de Paris, INSERM U970, Hôpital Européen Georges Pompidou, Department of Pharmacology, Paris, F-75015 France
| | - Pierre Boutouyrie
- University Paris Descartes, Assistance Publique – Hôpitaux de Paris, INSERM U970, Hôpital Européen Georges Pompidou, Department of Pharmacology, Paris, F-75015 France
| | - Dominique P Germain
- University of Versailles – Saint Quentin en Yvelines (UVSQ), Division of Medical Genetics, Hôpital Raymond Poincaré (AP-HP), Garches, France
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Weidemann F, Niemann M, Warnock DG, Ertl G, Wanner C. The Fabry Cardiomyopathy: Models for the Cardiologist. Annu Rev Med 2011; 62:59-67. [DOI: 10.1146/annurev-med-090910-085119] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Frank Weidemann
- Department of Medicine, Divisions of Cardiology and Nephrology, University Hospital, Wuerzburg, Germany;
| | - Markus Niemann
- Department of Medicine, Divisions of Cardiology and Nephrology, University Hospital, Wuerzburg, Germany;
| | - David G. Warnock
- Department of Medicine, University of Alabama, Birmingham, Alabama 35294
| | - Georg Ertl
- Department of Medicine, Divisions of Cardiology and Nephrology, University Hospital, Wuerzburg, Germany;
| | - Christoph Wanner
- Department of Medicine, Divisions of Cardiology and Nephrology, University Hospital, Wuerzburg, Germany;
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Machann W, Breunig F, Weidemann F, Sandstede J, Hahn D, Köstler H, Neubauer S, Wanner C, Beer M. Cardiac energy metabolism is disturbed in Fabry disease and improves with enzyme replacement therapy using recombinant human galactosidase A. Eur J Heart Fail 2010; 13:278-83. [PMID: 21149315 DOI: 10.1093/eurjhf/hfq211] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AIMS In vitro studies have shown impairment of energy metabolism in cardiac fibroblasts from Fabry patients. A recent in vivo study reported an association between cardiac energy metabolism and increased myocardial mass in Fabry patients. We therefore assessed possible disturbances of cardiac energy metabolism in Fabry patients by in vivo (31)P-MR-spectroscopy. Additionally, the effect of enzyme replacement therapy (ERT) on cardiac energetics was tested. METHODS AND RESULTS Twenty-three patients (41 ± 9 years; 10 females) with genetically proven Fabry disease were examined with a 1.5 T Scanner, and compared with an age-matched healthy control group. Eight patients underwent ERT and had follow-up examinations after 3 and 14 months. The high-energy phosphate molecules phosphocreatine (PCr) and adenosine triphosphate (ATP) were quantified in localized 31P-spectra by SLOOP (spectral localization with optimum point spread function). Cine- and late gadolinium enhancement (LGE) studies were also performed. When compared with healthy controls, Fabry patients demonstrated reduced PCr- (6.1 ± 1.9 vs. 8.8 ± 2.6 mmol/kg; P = 0.003) and ATP concentrations (3.9 ± 1.5 vs. 4.6 ± 1.0 mmol/kg; P = 0.048). During ERT, PCr concentrations increased (7.1 ± 1.5 mmol/kg vs. 6.1 ± 1.9; P < 0.05) and left ventricular mass decreased (215 ± 55 vs. 185 ± 45 g; P = 0.012). Disturbances in cardiac energetics were not correlated to the presence or absence of cardiac fibrosis on LGE. CONCLUSION Cardiac energy metabolism is disturbed in Fabry disease; this may play an important role in the pathogenesis of Fabry cardiomyopathy. Enzyme replacement therapy ameliorates energetic depression.
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Affiliation(s)
- Wolfram Machann
- Institut für Röntgendiagnostik, Universität Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany
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Abstract
Fabry disease (FD) is a progressive, X-linked inherited disorder of glycosphingolipid metabolism due to deficient or absent lysosomal α-galactosidase A activity. FD is pan-ethnic and the reported annual incidence of 1 in 100,000 may underestimate the true prevalence of the disease. Classically affected hemizygous males, with no residual α-galactosidase A activity may display all the characteristic neurological (pain), cutaneous (angiokeratoma), renal (proteinuria, kidney failure), cardiovascular (cardiomyopathy, arrhythmia), cochleo-vestibular and cerebrovascular (transient ischemic attacks, strokes) signs of the disease while heterozygous females have symptoms ranging from very mild to severe. Deficient activity of lysosomal α-galactosidase A results in progressive accumulation of globotriaosylceramide within lysosomes, believed to trigger a cascade of cellular events. Demonstration of marked α-galactosidase A deficiency is the definitive method for the diagnosis of hemizygous males. Enzyme analysis may occasionnally help to detect heterozygotes but is often inconclusive due to random X-chromosomal inactivation so that molecular testing (genotyping) of females is mandatory. In childhood, other possible causes of pain such as rheumatoid arthritis and 'growing pains' must be ruled out. In adulthood, multiple sclerosis is sometimes considered. Prenatal diagnosis, available by determination of enzyme activity or DNA testing in chorionic villi or cultured amniotic cells is, for ethical reasons, only considered in male fetuses. Pre-implantation diagnosis is possible. The existence of atypical variants and the availability of a specific therapy singularly complicate genetic counseling. A disease-specific therapeutic option - enzyme replacement therapy using recombinant human α-galactosidase A - has been recently introduced and its long term outcome is currently still being investigated. Conventional management consists of pain relief with analgesic drugs, nephroprotection (angiotensin converting enzyme inhibitors and angiotensin receptors blockers) and antiarrhythmic agents, whereas dialysis or renal transplantation are available for patients experiencing end-stage renal failure. With age, progressive damage to vital organ systems develops and at some point, organs may start to fail in functioning. End-stage renal disease and life-threatening cardiovascular or cerebrovascular complications limit life-expectancy of untreated males and females with reductions of 20 and 10 years, respectively, as compared to the general population. While there is increasing evidence that long-term enzyme therapy can halt disease progression, the importance of adjunctive therapies should be emphasized and the possibility of developing an oral therapy drives research forward into active site specific chaperones.
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Affiliation(s)
- Dominique P Germain
- University of Versailles - St Quentin en Yvelines, Faculté de Médecine Paris - Ile de France Ouest (PIFO), 78035 Versailles, France.
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61
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Sheppard MN, Cane P, Florio R, Kavantzas N, Close L, Shah J, Lee P, Elliott P. A detailed pathologic examination of heart tissue from three older patients with Anderson–Fabry disease on enzyme replacement therapy. Cardiovasc Pathol 2010; 19:293-301. [DOI: 10.1016/j.carpath.2009.05.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 04/16/2009] [Accepted: 05/22/2009] [Indexed: 10/20/2022] Open
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Mehta A, Beck M, Eyskens F, Feliciani C, Kantola I, Ramaswami U, Rolfs A, Rivera A, Waldek S, Germain DP. Fabry disease: a review of current management strategies. QJM 2010; 103:641-59. [PMID: 20660166 DOI: 10.1093/qjmed/hcq117] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Fabry disease is an X-linked inherited condition due to the absence or reduction of alpha-galactosidase activity in lysosomes, that results in accumulation of globotriaosylceramide (Gb3) and related neutral glycosphingolipids. Manifestations of Fabry disease include serious and progressive impairment of renal and cardiac function. In addition, patients experience pain, gastrointestinal disturbance, transient ischaemic attacks and strokes. Additional effects on the skin, eyes, ears, lungs and bones are often seen. The first symptoms of classic Fabry disease usually appear in childhood. Despite being X-linked, females can suffer the same severity of symptoms as males, and life expectancy is reduced in both females and males. Enzyme replacement therapy (ERT) can stabilize the progression of the disease. The rarity of the classic form of Fabry disease, however, means that there is a need to improve the knowledge and understanding that the majority of physicians have concerning Fabry disease, in order to avoid misdiagnosis and/or delayed diagnosis. This review aims to raise awareness of the signs and symptoms of Fabry disease; to provide a general diagnostic algorithm and to give an overview of the effects of ERT and concomitant treatments. We highlight a need to develop comprehensive international guidelines to optimize ERT and adjunctive therapy in patients with Fabry disease, including females and children.
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Affiliation(s)
- A Mehta
- Lysosomal Storage Disorders Unit, Department of Academic Haematology, Royal Free and University College Medical School, Rowland Hill Street, London NW3 2PF, UK.
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Parkinson-Lawrence EJ, Shandala T, Prodoehl M, Plew R, Borlace GN, Brooks DA. Lysosomal storage disease: revealing lysosomal function and physiology. Physiology (Bethesda) 2010; 25:102-15. [PMID: 20430954 DOI: 10.1152/physiol.00041.2009] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The discovery over five decades ago of the lysosome, as a degradative organelle and its dysfunction in lysosomal storage disorder patients, was both insightful and simple in concept. Here, we review some of the history and pathophysiology of lysosomal storage disorders to show how they have impacted on our knowledge of lysosomal biology. Although a significant amount of information has been accrued on the molecular genetics and biochemistry of lysosomal storage disorders, we still do not fully understand the mechanistic link between the storage material and disease pathogenesis. However, the accumulation of undegraded substrate(s) can disrupt other lysosomal degradation processes, vesicular traffic, and lysosomal biogenesis to evoke the diverse pathophysiology that is evident in this complex set of disorders.
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Affiliation(s)
- Emma J Parkinson-Lawrence
- Cell Biology of Disease Research Group, Sansom Institute for Health Research, Division of Health Science, University of South Australia, Adelaide, Australia
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64
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Cardiac challenges in patients with Fabry disease. Int J Cardiol 2010; 141:3-10. [DOI: 10.1016/j.ijcard.2009.08.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 06/15/2009] [Accepted: 08/11/2009] [Indexed: 11/24/2022]
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Rombach SM, Twickler TB, Aerts JMFG, Linthorst GE, Wijburg FA, Hollak CEM. Vasculopathy in patients with Fabry disease: current controversies and research directions. Mol Genet Metab 2010; 99:99-108. [PMID: 19900828 DOI: 10.1016/j.ymgme.2009.10.004] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Accepted: 10/09/2009] [Indexed: 11/28/2022]
Abstract
Fabry disease is an X-linked lysosomal storage disorder due to deficiency of the enzyme alpha-galactosidase A. The principal clinical manifestations of Fabry disease consist of cardiovascular complications including cerebrovascular, renal and cardiac disease but the pathophysiology of this specific vasculopathy is unclear. With the development of targeted treatment for Fabry disease, i.e. enzyme replacement therapy, it has become apparent that the removal of stored glycosphingolipid from the endothelial cells does not prevent progression of vascular disease in many patients. The aim of this study is to review the current available literature on vascular function tests, imaging and pathology studies and propose a hypothesis on the evolution of arterial complications in Fabry disease. Clearly, although premature atherosclerosis is suggested to occur, most studies describe absence of characteristic plaque formation. Smooth muscle cell hypertrophy, is probably the earliest feature of a complex vasculopathy, as in females and atypical cardiac variants, who have residual enzyme activity, no endothelial storage of significance is found. Subsequently, processes occur as observed in neo intima formation however with formation of more fibrotic structures. In the presence of a hyperdynamic circulation in combination with a less compliant vascular wall, it is hypothesized that upregulation of local renin angiotensine systems may occur. Angiotensin II is known to increase adhesion molecules, cytokines and chemokines and exerts a pro-inflammatory effect on leucocytes, endothelial cells and vascular smooth muscle cells. This enhances release of pro-thrombotic factors and opposes actions mediated through angiotensin 2 (AT2) receptor, including the release of nitric oxide (NO). A combination of reduced vascular compliance and activation of pro-thrombotic factors can lead to vascular complications in Fabry disease.
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Affiliation(s)
- S M Rombach
- Department of Endocrinology and Metabolism, Academic Medical Center, Amsterdam, The Netherlands
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Constantin T, Rákóczi É, Ponyi A, Ambrus C, Kádár K, Vastagh I, Dajnoki A, Tóth B, Bokrétás G, Müller V, Katona M, Csikós M, Fiedler O, Széchey R, Varga E, Rudas G, Kertész A, Molnár S, Kárpáti S, Nagy V, Magyar P, Mahdi M, Németh K, Bereczki D, Garami M, Erdős M, Maródi L, Fekete G. Fabry disease diagnostic guideline. Orv Hetil 2010; 151:243-9. [DOI: 10.1556/oh.2010.28795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A Fabry-kór a lizoszomális tárolási betegségek csoportjába tartozó, X-kromoszómához kötötten, recesszív módon öröklődő betegség, amely a globotriaosylceramid felhalmozódásához vezet a szervezet legkülönbözőbb szöveteiben. A betegség első tünetei többnyire gyermekkorban jelentkeznek, a progresszió során a betegek súlyos szervi károsodásokkal és korai halálozással számolhatnak. Elsősorban fiúk és férfiak érintettek, azonban a betegség tüneteit heterozigóta nők esetében is megfigyelhetjük, de náluk a kórkép súlyossága változó, általában enyhébb lefolyású. Az enzimpótló kezelések megjelenése szükségessé tette, hogy részletes diagnosztikus és terápiás protokollt dolgozzunk ki. A jelen dolgozatban megjelenő ajánlásokat egy, a magyarországi Fabry-betegek kezelésében aktívan részt vevő orvosokból, a diagnosztika területén dolgozó biológosukból és egyéb szakemberekből álló multidiszciplináris munkacsoport foglalta össze. A munkacsoport áttekintette a korábbi klinikai tanulmányokat, a publikált vizsgálatokat és a közelmúltban megjelent nemzetközi és nemzeti útmutatókat.
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Affiliation(s)
- Tamás Constantin
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar II. Gyermekgyógyászati Klinika Budapest Tűzoltó u. 7–9. 1094
| | - Éva Rákóczi
- 7 Debreceni Egyetem, OEC Infektológiai és Gyermekimmunológiai Tanszék Debrecen
| | - Andrea Ponyi
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar II. Gyermekgyógyászati Klinika Budapest Tűzoltó u. 7–9. 1094
| | - Csaba Ambrus
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Budapest
| | | | - Ildikó Vastagh
- 3 Semmelweis Egyetem, Általános Orvostudományi Kar Neurológiai Klinika Budapest
| | - Angéla Dajnoki
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar II. Gyermekgyógyászati Klinika Budapest Tűzoltó u. 7–9. 1094
| | - Beáta Tóth
- 7 Debreceni Egyetem, OEC Infektológiai és Gyermekimmunológiai Tanszék Debrecen
| | - Gergely Bokrétás
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar II. Gyermekgyógyászati Klinika Budapest Tűzoltó u. 7–9. 1094
| | - Veronika Müller
- 4 Semmelweis Egyetem, Általános Orvostudományi Kar Pulmonológiai Klinika Budapest
| | - Mária Katona
- 5 Semmelweis Egyetem, Általános Orvostudományi Kar Bőrgyógyászati Klinika Budapest
| | - Márta Csikós
- 5 Semmelweis Egyetem, Általános Orvostudományi Kar Bőrgyógyászati Klinika Budapest
| | - Orsolya Fiedler
- 6 Semmelweis Egyetem, Általános Orvostudományi Kar Szemészeti Klinika Budapest
| | - Rita Széchey
- 6 Semmelweis Egyetem, Általános Orvostudományi Kar Szemészeti Klinika Budapest
| | | | - Gábor Rudas
- 11 Semmelweis Egyetem, Tudásközpont MR Labor Budapest
| | | | - Sándor Molnár
- 9 Debreceni Egyetem, OEC Neurológiai Klinika Debrecen
| | - Sarolta Kárpáti
- 5 Semmelweis Egyetem, Általános Orvostudományi Kar Bőrgyógyászati Klinika Budapest
| | - Viktor Nagy
- 10 Gottsegen György Országos Kardiológiai Intézet Budapest
| | - Pál Magyar
- 4 Semmelweis Egyetem, Általános Orvostudományi Kar Pulmonológiai Klinika Budapest
| | - Mohamed Mahdi
- 7 Debreceni Egyetem, OEC Infektológiai és Gyermekimmunológiai Tanszék Debrecen
| | - Krisztina Németh
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar II. Gyermekgyógyászati Klinika Budapest Tűzoltó u. 7–9. 1094
| | - Dániel Bereczki
- 3 Semmelweis Egyetem, Általános Orvostudományi Kar Neurológiai Klinika Budapest
| | - Miklós Garami
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar II. Gyermekgyógyászati Klinika Budapest Tűzoltó u. 7–9. 1094
| | - Melinda Erdős
- 7 Debreceni Egyetem, OEC Infektológiai és Gyermekimmunológiai Tanszék Debrecen
| | - László Maródi
- 7 Debreceni Egyetem, OEC Infektológiai és Gyermekimmunológiai Tanszék Debrecen
| | - György Fekete
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar II. Gyermekgyógyászati Klinika Budapest Tűzoltó u. 7–9. 1094
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Chimenti C, Morgante E, Tanzilli G, Mangieri E, Critelli G, Gaudio C, Russo MA, Frustaci A. Angina in fabry disease reflects coronary small vessel disease. Circ Heart Fail 2009; 1:161-9. [PMID: 19808286 DOI: 10.1161/circheartfailure.108.769729] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Chest pain is frequently reported in Fabry disease (FD). However, its mechanism and clinical relevance are unclear. METHODS AND RESULTS Basal troponin I level, exercise stress test, single-photon emission computed tomography imaging with (99m)Tc sestamibi, coronary angiography with thrombolysis in myocardial infarction (TIMI) frame count and left ventricular angiography and endomyocardial biopsy were obtained in 13 patients with FD with angina. Ratio of external to lumen diameter of intramural arteries (E/L ratio), myocyte diameter, and extent of fibrosis were morphometrically evaluated by using tissue sections. Controls for coronary angiography and histology were 25 patients with FD without angina and 20 mitral stenosis patients with normal left ventricular function. Troponin I level was elevated in 6 of the 13 patients. Exercise stress test showed evidence of myocardial ischemia, and single-photon emission computed tomography was positive for stress-induced perfusion defects in all patients with FD with angina. Epicardial coronaries were structurally normal but showed slow flow in all and were associated with aneurisms of posterior left ventricular wall in 3 cases. Histology showed remarkable lumen narrowing of most intramural arteries (mean E/L ratio=3.5+/-1.2; P<0.001 versus both control groups), because of hypertrophy and proliferation of smooth muscle and endothelial cells, both engulfed by glycosphingolipids. Replacement fibrosis exceeded that of both controls (P<0.001). Small vessel disease correlated with coronary slow flow and extent of fibrosis, but did not with patients' age, sex, and degree of left ventricular hypertrophy. CONCLUSIONS patients with FD with angina have perfusion defects, slow coronary flow, and luminal narrowing of intramural arteries. Small vessel disease may contribute to symptomatic limitation and progressive myocardial dysfunction.
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Affiliation(s)
- Cristina Chimenti
- Heart and Great Vessels Attilio Reale Department, La Sapienza University, Rome, Italy
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Barbey F, Qanadli SD, Juli C, Brakch N, Palacek T, Rizzo E, Jeanrenaud X, Eckhardt B, Linhart A. Aortic remodelling in Fabry disease. Eur Heart J 2009; 31:347-53. [DOI: 10.1093/eurheartj/ehp426] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Zhou J, Weng D, Zhou F, Pan K, Song H, Wang Q, Wang H, Wang H, Li Y, Huang L, Zhang H, Huang W, Xia J. Patient-derived renal cell carcinoma cells fused with allogeneic dendritic cells elicit anti-tumor activity: in vitro results and clinical responses. Cancer Immunol Immunother 2009; 58:1587-97. [PMID: 19221746 PMCID: PMC11030900 DOI: 10.1007/s00262-009-0668-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Accepted: 01/21/2009] [Indexed: 10/21/2022]
Abstract
Renal cell carcinoma (RCC) has been shown to be susceptible to immunotherapeutic treatment strategies. In the present study, patient-derived tumor cells were fused with allogeneic dendritic cells (DC) to elicit anti-tumor activity against RCC. DC from HLA-A2+ healthy donors were fused with primary RCC cells from ten patients. Phenotype of fusion cells were characterized by flow cytometer and confocal microscopy. In vitro, T cell proliferation, IFN-gamma secretion and cytotoxic T lymphocytes (CTL) activity elicited by allogeneic DC/RCC fusion cells were assessed. Clinically, ten patients were vaccinated with allogeneic DC/RCC fusion vaccine. The adverse effects and toxicity were observed. The clinical response was evaluated by CT scans. After fusion, the created hybrids expressed both tumor associated antigen and DC-derived molecules and could stimulate the proliferation and IFN-gamma secretion of T cells as well as elicit strong CTL activity against RCC cells in vitro. In vivo, no serious adverse effects, toxicity, or signs of autoimmune disease were observed after vaccination therapy. Percentage of T lymphocyte subsets in peripheral blood of patients was increased significantly. One of ten patients exhibited a partial response with regression of lung metastases. Six patients showed stable disease with stabilization of previously progressive disease (follow up 1.5 years). The PR and SD responses, exhibited by 7/10 patients who received the allogeneic DC/RCC fusion vaccine treatment, suggest that this approach is safe and can elicit immunological responses in a significant portion of patients with RCC.
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Affiliation(s)
- Jun Zhou
- State Key Laboratory of Oncology in Southern China, 510060 Guangzhou, People’s Republic of China
- Biotherapy Center, Cancer Center, Sun Yat-sen University, 651 Dongfeng Road East, 510060 Guangzhou, People’s Republic of China
| | - Desheng Weng
- State Key Laboratory of Oncology in Southern China, 510060 Guangzhou, People’s Republic of China
- Biotherapy Center, Cancer Center, Sun Yat-sen University, 651 Dongfeng Road East, 510060 Guangzhou, People’s Republic of China
| | - Fangjian Zhou
- Department of Urology, Cancer Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Ke Pan
- State Key Laboratory of Oncology in Southern China, 510060 Guangzhou, People’s Republic of China
- Biotherapy Center, Cancer Center, Sun Yat-sen University, 651 Dongfeng Road East, 510060 Guangzhou, People’s Republic of China
| | - Haifeng Song
- State Key Laboratory of Oncology in Southern China, 510060 Guangzhou, People’s Republic of China
- Biotherapy Center, Cancer Center, Sun Yat-sen University, 651 Dongfeng Road East, 510060 Guangzhou, People’s Republic of China
| | - Qijing Wang
- State Key Laboratory of Oncology in Southern China, 510060 Guangzhou, People’s Republic of China
- Biotherapy Center, Cancer Center, Sun Yat-sen University, 651 Dongfeng Road East, 510060 Guangzhou, People’s Republic of China
| | - Huan Wang
- Biotherapy Center, Cancer Center, Sun Yat-sen University, 651 Dongfeng Road East, 510060 Guangzhou, People’s Republic of China
| | - Hui Wang
- State Key Laboratory of Oncology in Southern China, 510060 Guangzhou, People’s Republic of China
- Department of Urology, Cancer Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yongqiang Li
- State Key Laboratory of Oncology in Southern China, 510060 Guangzhou, People’s Republic of China
- Biotherapy Center, Cancer Center, Sun Yat-sen University, 651 Dongfeng Road East, 510060 Guangzhou, People’s Republic of China
| | - Lixi Huang
- State Key Laboratory of Oncology in Southern China, 510060 Guangzhou, People’s Republic of China
- Biotherapy Center, Cancer Center, Sun Yat-sen University, 651 Dongfeng Road East, 510060 Guangzhou, People’s Republic of China
| | - Huakun Zhang
- State Key Laboratory of Oncology in Southern China, 510060 Guangzhou, People’s Republic of China
- Biotherapy Center, Cancer Center, Sun Yat-sen University, 651 Dongfeng Road East, 510060 Guangzhou, People’s Republic of China
| | - Wei Huang
- State Key Laboratory of Oncology in Southern China, 510060 Guangzhou, People’s Republic of China
- Biotherapy Center, Cancer Center, Sun Yat-sen University, 651 Dongfeng Road East, 510060 Guangzhou, People’s Republic of China
| | - Jianchuan Xia
- State Key Laboratory of Oncology in Southern China, 510060 Guangzhou, People’s Republic of China
- Biotherapy Center, Cancer Center, Sun Yat-sen University, 651 Dongfeng Road East, 510060 Guangzhou, People’s Republic of China
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Evaluation of a low dose, after a standard therapeutic dose, of agalsidase beta during enzyme replacement therapy in patients with Fabry disease. Genet Med 2009; 11:256-64. [PMID: 19265719 DOI: 10.1097/gim.0b013e3181981d82] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Fabry disease, a genetic deficiency of alpha-galactosidase A, is characterized by pathogenic cellular accumulation of globotriaosylceramide. During clinical trials, recombinant human alpha-galactosidase A (agalsidase beta; Fabrazyme, Genzyme Corporation, Cambridge, MA), infused intravenously at 1.0 mg/kg every 2 weeks for 6 months, cleared or reduced globotriaosylceramide in renal, cardiac, and dermal microvascular endothelia and other cells, with results sustained for up to 5 years in most patients evaluated. This study explored whether a lower dose could maintain globotriaosylceramide clearance achieved with 1.0 mg/kg. METHODS Cellular globotriaosylceramide levels were assessed histologically in kidney and skin biopsies from 21 adult Fabry males treated for 6 months at 1.0 mg/kg/2 weeks followed by 18 months at 0.3 mg/kg/2 weeks. RESULTS In kidney interstitial capillary endothelium, the primary endpoint, globotriaosylceramide clearance was achieved in 100% of patients with 1.0 mg/kg and maintained in 90% with 0.3 mg/kg. In seven other renal cell types and superficial dermal capillary endothelium, globotriaosylceramide reduction or clearance was maintained with 0.3 mg/kg in approximately 70% of patients. CONCLUSIONS A lower dose of agalsidase beta may be sufficient in some, but not all, patients with Fabry disease to maintain the cellular globotriaosylceramide clearance achieved with 1.0 mg/kg/2 weeks. Long-term clinical effects of transitioning to the lower dose have not been evaluated.
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Brakch N, Dormond O, Bekri S, Golshayan D, Correvon M, Mazzolai L, Steinmann B, Barbey F. Evidence for a role of sphingosine-1 phosphate in cardiovascular remodelling in Fabry disease. Eur Heart J 2009; 31:67-76. [PMID: 19773225 DOI: 10.1093/eurheartj/ehp387] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS A hallmark of Fabry disease is the concomitant development of left-ventricular hypertrophy and arterial intima-media thickening, the pathogenesis of which is thought to be related to the presence of a plasmatic circulating growth-promoting factor. We therefore characterized the plasma of patients with Fabry disease in order to identify this factor. METHODS AND RESULTS Using a classical biochemical strategy, we isolated and identified sphingosine-1 phosphate (S1P) as a proliferative factor present in the plasma of patients with Fabry disease. Plasma S1P levels were significantly higher in 17 patients with Fabry disease compared with 17 healthy controls (225 +/- 40 vs. 164 +/- 17 ng/mL; P = 0.005). There was a positive correlation between plasma S1P levels and both common carotid artery intima-media thickness and left-ventricular mass index (r(2) = 0.47; P = 0.006 and r(2) = 0.53; P = 0.0007, respectively). In an experimental model, mice treated with S1P developed cardiovascular remodelling similar to that observed in patients with Fabry disease. CONCLUSION Sphingosine-1 phosphate participates in cardiovascular remodelling in Fabry disease. Our findings have implications for the treatment of cardiovascular involvement in Fabry disease.
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Affiliation(s)
- Noureddine Brakch
- Service of Angiology and Vascular Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, 5 Rue Pierre Decker, 1011 Lausanne, Switzerland.
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Abstract
Fabry disease, an X-linked disorder of glycosphingolipids that is caused by the deficiency of alpha-galactosidase A, is associated with dysfunction of many cell types and includes a systemic vasculopathy. As a result, patients have a markedly increased risk of developing small-fiber peripheral neuropathy, stroke, myriad cardiac manifestations and chronic renal disease. Virtually all complications of Fabry disease are non-specific in nature and clinically indistinguishable from similar abnormalities that occur in the context of more common disorders in the general population. Although Fabry disease was originally thought to be very rare, recent studies have found a much higher incidence of mutations of the GLA gene, suggesting that this disorder is under-diagnosed. Although the etiology of Fabry disease has been known for many years, the mechanism by which the accumulating alpha-D-galactosyl moieties cause this multi-organ disorder has only recently been studied and is yet to be completely elucidated. Specific therapy for Fabry disease has been developed in the last few years but its role in the management of the disorder is still being investigated. Fortunately, standard 'non-specific' medical and surgical therapy is effective in slowing deterioration or compensating for organ failure in patients with Fabry disease. All these aspects are discussed in detail in the present review.
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Affiliation(s)
- Raphael Schiffmann
- Institute of Metabolic Disease, Baylor Research Institute, 3812 Elm Street, Dallas, TX 75226, USA.
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Kovarnik T, Mintz GS, Karetova D, Horak J, Bultas J, Skulec R, Skalicka H, Aschermann M, Elleder M, Linhart A. Intravascular ultrasound assessment of coronary artery involvement in Fabry disease. J Inherit Metab Dis 2008; 31:753-60. [PMID: 18998239 DOI: 10.1007/s10545-008-0794-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Revised: 07/29/2008] [Accepted: 08/06/2008] [Indexed: 11/29/2022]
Abstract
AIM We used intravascular ultrasound (IVUS) to characterize coronary artery involvement in patients with Fabry disease (FD). METHODS Nine FD patients (5 women) were matched to 10 control patients (5 women) chosen from our IVUS database. Standard volumetric IVUS analyses were performed along with assessment of plaque echodensity. RESULTS Plaques in FD patients were diffuse and hypoechogenic compared with more focal and more echogenic lesions in control patients. Echogenicity of plaques was significantly lower in FD patients (median 30.7 +/- 12.9 vs 55.9 +/- 15.7, p = 0.0052, mean 37.2 +/- 15.6 vs 66.2 +/- 13.3, p = 0.0014). Diffusiveness was assessed as differences between mean and median plaque burden versus the plaque burden in each of the analysed cross-sections. These differences were lower in FD vs controls (5.8 +/- 4.8 vs 8.7 +/- 6.6, p < 0.001 for mean, and 5.8 +/- 4.9 vs 8.8 +/- 7.3, p < 0.001 for median) indicating a more diffuse involvement. The occurrence of lipid cores was significantly higher in FD patients than in controls (2.4 +/- 1.5 vs 1.0 +/- 0.94, p = 0.02). CONCLUSION IVUS showed diffuse hypoechogenic plaques in patients with FD. The explanation may be higher lipid content in plaques and accumulation of glycosphingolipid in smooth-muscle and endothelial cells.
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Affiliation(s)
- T Kovarnik
- Second Department of Internal Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.
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Spinelli L, Nicolai E, Acampa W, Imbriaco M, Pisani A, Rao MAE, Scopacasa F, Cianciaruso B, De Luca N, Cuocolo A. Cardiac performance during exercise in patients with Fabry's disease. Eur J Clin Invest 2008; 38:910-7. [PMID: 19021715 DOI: 10.1111/j.1365-2362.2008.02053.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fatigability and dyspnoea on effort are present in many patients with Fabry's disease. We assessed the determinants of cardiac performance during exercise in patients with Fabry's disease and preserved left ventricular ejection fraction at rest. MATERIALS AND METHODS Sixteen patients with Fabry's disease and 16 control subjects underwent radionuclide angiography at rest and during exercise, tissue Doppler echocardiography and magnetic resonance imaging at rest. RESULTS The exercise-induced change in stroke volume was +25 +/- 14% in controls and +5.8 +/- 19% in patients with Fabry's disease (P < 0.001). In 10 patients (group 1), the stroke volume increased (+19 +/- 10%), and in 6 patients (group 2) it decreased (-16 +/- 9%) with exercise. Patients of group 2 were older, had worse renal function, higher left ventricular mass and impaired diastolic function compared to group 1. The abnormal stroke volume response to exercise in group 2 was associated with a decrease in end-diastolic volume (P < 0.001) and a lack of reduction of end-systolic volume (P < 0.01) compared with both controls and group 1. The ratio of peak early-diastolic velocity from mitral filling to peak early-diastolic mitral annulus velocity was the only independent predictor of exercise-induced change in stroke volume (B -0.44; SE 0.119; beta-0.70; P < 0.005). CONCLUSIONS The majority of patients with Fabry's disease were able to augment stroke volume during exercise by increasing end-diastolic volume, whereas patients with more advanced cardiac involvement may experience the inability to increase cardiac output by the Frank Starling mechanism.
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Affiliation(s)
- L Spinelli
- Department of Internal Medicine, Cardiovascular and Immunological Sciences, University Federico II, Naples, Italy
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Poorthuis BJ, Groener JE, Ottenhoff R, Wijburg FA, Hollak CE, Aerts JM. Elevated globotriaosylsphingosine as a hallmark of Fabry disease. Chem Phys Lipids 2008. [DOI: 10.1016/j.chemphyslip.2008.05.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chimenti C, Hamdani N, Boontje NM, DeCobelli F, Esposito A, Bronzwaer JGF, Stienen GJM, Russo MA, Paulus WJ, Frustaci A, van der Velden J. Myofilament degradation and dysfunction of human cardiomyocytes in Fabry disease. THE AMERICAN JOURNAL OF PATHOLOGY 2008; 172:1482-90. [PMID: 18467700 PMCID: PMC2408409 DOI: 10.2353/ajpath.2008.070576] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/21/2008] [Indexed: 11/20/2022]
Abstract
Early detection of myocardial dysfunction in Fabry disease (FD) cardiomyopathy suggests the contribution of myofilament structural alterations. Six males with untreated FD cardiomyopathy submitted to cardiac studies, including tissue Doppler imaging and left ventricular endomyocardial biopsy. Active and resting tensions before and after treatment with protein kinase A (PKA) were determined in isolated Triton-permeabilized cardiomyocytes. Cardiomyocyte cross-sectional area, glycosphingolipid vacuole area, myofibrillolysis, and extent of fibrosis were also determined. Biopsies of mitral stenosis in patients with normal left ventricles served as controls. Active tension was four times lower in FD cardiomyocytes and correlated with extent of myofibrillolysis. Resting tension was six times higher in FD cardiomyocytes than in controls. PKA treatment decreased resting tension but did not affect active force. Protein analysis revealed troponin I and desmin degradation products. FD cardiomyocytes were significantly larger and filled with glycosphingolipids. Fibrosis was mildly increased compared with controls. Tissue Doppler imaging lengthening and shortening velocities were reduced in FD cardiomyocytes compared with controls, correlating with resting and active tensions, respectively, but not with cardiomyocyte area, percentage of glycosphingolipids, or extent of fibrosis. In conclusion, myofilament degradation and dysfunction contribute to FD cardiomyopathy. Partial reversal of high resting tension after pharmacological PKA treatment of cardiomyocytes suggests potential benefits from enzyme replacement therapy and/or energy-releasing agents.
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Affiliation(s)
- Cristina Chimenti
- Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele La Pisana, Rome, Italy
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Elevated globotriaosylsphingosine is a hallmark of Fabry disease. Proc Natl Acad Sci U S A 2008; 105:2812-7. [PMID: 18287059 DOI: 10.1073/pnas.0712309105] [Citation(s) in RCA: 514] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Fabry disease is an X-linked lysosomal storage disease caused by deficiency of alpha-galactosidase A that affects males and shows disease expression in heterozygotes. The characteristic progressive renal insufficiency, cardiac involvement, and neuropathology usually are ascribed to globotriaosylceramide accumulation in the endothelium. However, no direct correlation exists between lipid storage and clinical manifestations, and treatment of patients with recombinant enzymes does not reverse several key signs despite clearance of lipid from the endothelium. We therefore investigated the possibility that globotriaosylceramide metabolites are a missing link in the pathogenesis. We report that deacylated globotriaosylceramide, globotriaosylsphingosine, and a minor additional metabolite are dramatically increased in plasma of classically affected male Fabry patients and plasma and tissues of Fabry mice. Plasma globotriaosylceramide levels are reduced by therapy. We show that globotriaosylsphingosine is an inhibitor of alpha-galactosidase A activity. Furthermore, exposure of smooth muscle cells, but not fibroblasts, to globotriaosylsphingosine at concentrations observed in plasma of patients promotes proliferation. The increased intima-media thickness in Fabry patients therefore may be related to the presence of this metabolite. Our findings suggest that measurement of circulating globotriaosylsphingosine will be useful to monitor Fabry disease and may contribute to a better understanding of the disorder.
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Genetic polymorphisms of vitamin D receptor (VDR) in Fabry disease. Genetica 2008; 134:377-83. [PMID: 18278558 DOI: 10.1007/s10709-008-9245-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Accepted: 02/05/2008] [Indexed: 10/22/2022]
Abstract
Fabry disease, an X-linked inborn error of metabolism, is characterized by multi-organ involvement including cardiac signs of left ventricular hypertrophy and abnormal intima-medial (IMT) thickening of arteries, progressive renal failure, neurological involvement, and more. The vitamin D receptor (VDR) and an enzyme producing vitamin D3 result in an autocrine loop with direct effects on blood vessels. The purpose of this study is to assess VDR polymorphisms (BsmI, FokI, ApaI, and TaqI) relative to clinically important disease parameters using a disease-specific severity score (MSSI) and haplotype analysis. There were statistically significant differences between females (43% of 74 patients) and males in MSSI total scores, and in general and neurologic sub-scores. There appears to be a protective effect of the TaqI tt genotype so that there were significantly lower scores in clinical categories between those with the tt genotype versus those with the TT genotype. Multivariate models of haplotypes with MSSI scores reveal that T-A-f-B and t-a-F-b haplotypes of the VDR gene polymorphisms are significantly associated with variation in the Fabry phenotype. Despite the limitations of using the MSSI score as a clinical correlate, these results are provocative and further studies in larger cohorts with more males are recommended.
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Hollak CEM, Vedder AC, Linthorst GE, Aerts JMFG. Novel therapeutic targets for the treatment of Fabry disease. Expert Opin Ther Targets 2007; 11:821-33. [PMID: 17504019 DOI: 10.1517/14728222.11.6.821] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Fabry disease is an X-linked lysosomal storage disorder resulting from deficient activity of alpha-galactosidase A. The traditional concept that is used to explain the complications of the disease involves progressive accumulation of globotriaosylceramide in endothelial and smooth muscle cells, resulting in vascular damage. Clinically, progressive renal insufficiency, cardiac involvement and brain pathology evolves. Two pharmaceutical companies have developed enzyme replacement therapy in Fabry disease. Although the first clinical trials showed great promise, it is clear that long-term effects are not as robust as was anticipated. Stabilisation of renal function and decreases in cardiac hypertrophy has been observed, but some patients may experience progressive complications. As there are recent indications that serum components contribute to the pathophysiology of Fabry disease, fundamental studies are needed to unravel the precise role and identity of these factors. Combination of these basic studies with clinical follow up may ultimately reveal when the 'point of no return' is reached. Advanced renal insufficiency seems to be a clinical indicator of lack of response, but other signs and symptoms are probably related to adverse outcome. It is anticipated that in the future controlled studies in early symptomatic or presymptomatic patients will be required. In addition, alternative strategies such as substrate reduction or chaperone therapy, either alone or in combination with enzyme replacement therapy, should be explored. Because Fabry disease is rare, collaborative efforts should be undertaken and openness of data should be strived for.
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Affiliation(s)
- Carla E M Hollak
- Academic Medical Center, Department of Internal Medicine, Division of Endocrinology and Metabolism, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Moore DF, Krokhin OV, Beavis RC, Ries M, Robinson C, Goldin E, Brady RO, Wilkins JA, Schiffmann R. Proteomics of specific treatment-related alterations in Fabry disease: a strategy to identify biological abnormalities. Proc Natl Acad Sci U S A 2007; 104:2873-8. [PMID: 17301227 PMCID: PMC1797627 DOI: 10.1073/pnas.0611315104] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Fabry disease is inherited as an X-linked disorder secondary to deficiency of alpha-galactosidase A, resulting in abnormal metabolism of substances containing alpha-d-galactosyl moieties. As a consequence, a multisystem disorder develops, culminating in strokes, progressive renal, and cardiac dysfunction. Signs and symptoms of Fabry disease become manifest in childhood, but diagnosis is often delayed. Thirteen children with Fabry disease (age range, 6.5-17 years) were studied as part of a 6-month open-label study of enzyme replacement therapy (ERT) with agalsidase alfa. Paired serum samples were drawn at the start of the study and after 6 months of ERT. Global protein changes in paired samples were compared by using differential stable isotope labeling of peptide lysine residues with O-methylisourea and subsequent nanoHPLC-tandem MS. Statistically significant decreases were observed for five proteins following ERT: alpha(2)-HS glycoprotein, vitamin D-binding protein, transferrin, Ig-alpha-2 C chain, and alpha-2-antiplasmin. The presence of low levels of alpha-2-antiplasmin and plasminogen was confirmed by alternate means in 34 consecutive patients, including four of five ERT-naïve subjects. Decreased alpha-2-antiplasmin was associated with a parallel increase in circulating VEGF. Soluble VEGF receptor-2 was significantly elevated in plasma of patients compared with pediatric controls and decreased with ERT. These results suggest previously unknown abnormalities of fibrinolysis and angiogenesis factors in Fabry disease. We demonstrated the feasibility of identifying treatment-specific alterations in a small number of subjects that point to previously unsuspected disease-related biological abnormalities.
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Affiliation(s)
- David F. Moore
- *Section of Neurology and Section of Proteomics and System Biology, and
| | - Oleg V. Krokhin
- Manitoba Center for Proteomics and System Biology, University of Manitoba, Winnipeg, ON, Canada R3C 4J5; and
| | - Ronald C. Beavis
- Manitoba Center for Proteomics and System Biology, University of Manitoba, Winnipeg, ON, Canada R3C 4J5; and
| | - Markus Ries
- Developmental and Metabolic Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892-1260
| | - Chevalia Robinson
- Developmental and Metabolic Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892-1260
| | - Ehud Goldin
- Developmental and Metabolic Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892-1260
| | - Roscoe O. Brady
- Developmental and Metabolic Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892-1260
- To whom correspondence should be addressed. E-mail:
| | - John A. Wilkins
- Manitoba Center for Proteomics and System Biology, University of Manitoba, Winnipeg, ON, Canada R3C 4J5; and
| | - Raphael Schiffmann
- Developmental and Metabolic Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892-1260
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