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Zakaria Y, Yahya N, Kissani N. Cochleovestibular Signs As the First Manifestation of Fabry Disease: A Case Report and Literature Review. Cureus 2024; 16:e57289. [PMID: 38690505 PMCID: PMC11058903 DOI: 10.7759/cureus.57289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2024] [Indexed: 05/02/2024] Open
Abstract
Fabry disease (FD) is an X-linked lysosomal storage disorder characterized by alpha-galactosidase A deficiency, resulting in globotriaosylceramide accumulation and diverse clinical manifestations. We report a case of a 22-year-old male presenting with cochleovestibular disorders as the initial FD manifestation, alongside a literature review. Diagnostic evaluation revealed reduced alpha-galactosidase A activity, confirming FD. Cochleovestibular involvement, although underexplored, significantly affects FD patients, often presenting with sudden deafness or sensorineural hearing loss. Prompt diagnosis and enzyme replacement therapy are crucial for managing FD. Otolaryngologists play a key role in early detection and intervention. This case underscores the importance of considering FD in cases of hearing loss, tinnitus, or vertigo, emphasizing the need for heightened awareness among healthcare providers.
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Affiliation(s)
- Yasmina Zakaria
- Neurology, Mohamed VI University Hospital of Marrakesh, Cadi Ayad University, Marrakesh, MAR
- Neuroscience, Neuroscience Research Laboratory, Marrakesh Medical School, Marrakesh, MAR
| | - Naji Yahya
- Neurology, Agadir University Hospital, Agadir, MAR
- Research, Neurosciences Innovation Cognition Ethique (NICE) Research Team, Rein Endocrinologie Gastroentérologie Neurosciences Ethique (REGNE) Research Laboratory, Faculty of Medicine and Pharmacy, Ibn Zohr University, Marrakesh, MAR
| | - Najib Kissani
- Neurology, Mohamed VI University Hospital of Marrakesh, Cadi Ayad University, Marrakesh, MAR
- Neuroscience, Neuroscience Research Laboratory, Marrakesh Medical School, Marrakesh, MAR
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2
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Politt K, Gaik C. Cesarean section under spinal anesthesia in a first-time gravida with Fabry disease. Int J Obstet Anesth 2024; 57:103958. [PMID: 38071129 DOI: 10.1016/j.ijoa.2023.103958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/13/2023] [Accepted: 11/15/2023] [Indexed: 02/04/2024]
Affiliation(s)
- K Politt
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Hessen, Germany.
| | - C Gaik
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Hessen, Germany
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3
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Izhar R, Borriello M, La Russa A, Di Paola R, De A, Capasso G, Ingrosso D, Perna AF, Simeoni M. Fabry Disease in Women: Genetic Basis, Available Biomarkers, and Clinical Manifestations. Genes (Basel) 2023; 15:37. [PMID: 38254927 PMCID: PMC10815601 DOI: 10.3390/genes15010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/24/2024] Open
Abstract
Fabry Disease (FD) is a rare lysosomal storage disorder caused by mutations in the GLA gene on the X chromosome, leading to a deficiency in α-galactosidase A (AGAL) enzyme activity. This leads to the accumulation of glycosphingolipids, primarily globotriaosylceramide (Gb3), in vital organs such as the kidneys, heart, and nervous system. While FD was initially considered predominantly affecting males, recent studies have uncovered that heterozygous Fabry women, carrying a single mutated GLA gene, can manifest a wide array of clinical symptoms, challenging the notion of asymptomatic carriers. The mechanisms underlying the diverse clinical manifestations in females remain not fully understood due to X-chromosome inactivation (XCI). XCI also known as "lyonization", involves the random inactivation of one of the two X chromosomes. This process is considered a potential factor influencing phenotypic variation. This review delves into the complex landscape of FD in women, discussing its genetic basis, the available biomarkers, clinical manifestations, and the potential impact of XCI on disease severity. Additionally, it highlights the challenges faced by heterozygous Fabry women, both in terms of their disease burden and interactions with healthcare professionals. Current treatment options, including enzyme replacement therapy, are discussed, along with the need for healthcare providers to be well-informed about FD in women, ultimately contributing to improved patient care and quality of life.
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Affiliation(s)
- Raafiah Izhar
- Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (R.D.P.); (A.D.)
| | - Margherita Borriello
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.B.); (D.I.)
| | - Antonella La Russa
- Department of Sperimental Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Rossella Di Paola
- Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (R.D.P.); (A.D.)
| | - Ananya De
- Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (R.D.P.); (A.D.)
| | | | - Diego Ingrosso
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.B.); (D.I.)
| | - Alessandra F. Perna
- Nephrology and Dialysis Unit, Department of Translation Medical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Mariadelina Simeoni
- Nephrology and Dialysis Unit, Department of Translation Medical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
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Esposito P, Caputo C, Repetto M, Somaschini A, Pietro B, Colomba P, Zizzo C, Parodi A, Zanetti V, Canepa M, Eustachi V, Sanguineri F, Mandich P, Viazzi F. Diagnosing Fabry nephropathy: the challenge of multiple kidney disease. BMC Nephrol 2023; 24:344. [PMID: 37990184 PMCID: PMC10664682 DOI: 10.1186/s12882-023-03388-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023] Open
Abstract
Fabry disease (FD) is an X-linked inherited lysosomal disorder due to a deficiency of the enzyme alpha-galactosidase A (α-gla) due to mutations in the GLA gene. These mutations result in plasma and lysosome accumulation of glycosphingolipids, leading to progressive organ damage and reduced life expectancy. Due to the availability of specific disease-modifying treatments, proper and timely diagnosis and therapy are essential to prevent irreversible complications. However, diagnosis of FD is often delayed because of the wide clinical heterogeneity of the disease and multiple organ involvement developing in variable temporal sequences. This observation is also valid for renal involvement, which may manifest with non-specific signs, such as proteinuria and chronic kidney disease, which are also common in many other nephropathies. Moreover, an additional confounding factor is the possibility of the coexistence of FD with other kidney disorders. Thus, suspecting and diagnosing FD nephropathy in patients with signs of kidney disease may be challenging for the clinical nephrologist. Herein, also through the presentation of a unique case of co-occurrence of autosomal dominant polycystic kidney disease and FD, we review the available literature on cases of coexistence of FD and other renal diseases and discuss the implications of these conditions. Moreover, we highlight the clinical, laboratory, and histological elements that may suggest clinical suspicion and address a proper diagnosis of Fabry nephropathy.
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Affiliation(s)
- Pasquale Esposito
- Department of Internal Medicine, University of Genoa, Genoa, Italy.
- Unit of Nephrology, Dialysis, and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Carmela Caputo
- Unit of Nephrology and Dialysis, Ospedale San Paolo, Savona, Italy
| | - Monica Repetto
- Unit of Nephrology and Dialysis, Ospedale San Paolo, Savona, Italy
| | - Alberto Somaschini
- Division of Cardiology and Cardiac Intensive Care Unit, Ospedale San Paolo, Savona, Italy
| | - Bellone Pietro
- Division of Cardiology and Cardiac Intensive Care Unit, Ospedale San Paolo, Savona, Italy
| | - Paolo Colomba
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), Palermo, Italy
| | - Carmela Zizzo
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), Palermo, Italy
| | - Angelica Parodi
- Unit of Nephrology, Dialysis, and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Valentina Zanetti
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Unit of Nephrology, Dialysis, and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marco Canepa
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Virginia Eustachi
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesca Sanguineri
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy
| | - Paola Mandich
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Unit of Nephrology, Dialysis, and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Souter V, Prigmore B, Becraft E, Repass E, Smart T, Sanapareddy N, Schweitzer M, Ortiz JB, Wang Y, Benn P. Reproductive Carrier Screening Results With Maternal Health Implications During Pregnancy. Obstet Gynecol 2023; 142:1208-1216. [PMID: 37562044 DOI: 10.1097/aog.0000000000005318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/22/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE To identify conditions on a reproductive carrier screening panel with the potential for carrier manifestations during pregnancy and review the implications for obstetric care. METHODS This was a retrospective cross-sectional study of consecutive samples from female patients aged 18-55 years submitted to a commercial laboratory for a 274-gene carrier screening panel (January 2020 to September 2022). A literature review was performed to identify genes on the panel with potential for pregnancy complications in carriers. Carrier expression and published recommendations for clinical management were reviewed. RESULTS We identified 12 genes with potential for carrier manifestations during pregnancy based on reports in the literature: nine with manifestations irrespective of the fetal genetic status ( ABCB11 , COL4A3 , COL4A4 , COL4A5 , DMD , F9 , F11 , GLA , and OTC ) and three ( CPT1A , CYP19A1 , and HADHA ) with manifestations only if the fetus is affected by the condition. Manifestations included cardiomyopathy, hemorrhage, gestational hypertensive disorders, cholestasis of pregnancy, acute fatty liver, hyperammonemic crisis, and maternal virilization. Published recommendations for carrier management were identified for 11 of the 12 genes. Of 91,637 tests performed during the study period, a pathogenic or likely pathogenic variant was identified in 2,139 (2.3%), giving a carrier frequency for any of the 12 genes of 1 in 43 (95% CI 1/41-45) 1,826 (2.0%) of the study population were identified as carriers for one of the nine genes with the potential for carrier manifestations irrespective of an affected or unaffected fetus. CONCLUSION Approximately 1 in 40 female patients were identified as carriers for a condition with potential for maternal manifestations in pregnancy, including some serious or even life-threatening complications. Obstetric care professionals should be aware of the possibility of pregnancy complications among carriers and the available recommendations for management. FUNDING SOURCE This study was funded by Natera, Inc.
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Affiliation(s)
- Vivienne Souter
- Natera, Inc., Austin, Texas; and the University of Connecticut Health Center, Farmington, Connecticut
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Choi SJ, Kim SH, Lee MS, Park S, Cho E, Han SS, Koh ES, Chung BH, Jeong KH, Bae EH, Lee EY, Kwon YJ. A questionnaire survey on the diagnosis and treatment of Fabry nephropathy in clinical practice. Kidney Res Clin Pract 2023; 42:628-638. [PMID: 37448283 PMCID: PMC10565450 DOI: 10.23876/j.krcp.22.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/27/2023] [Accepted: 02/06/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Fabry nephropathy is characterized by a deficiency of lysosomal alpha-galactosidase A, which results in proteinuria and kidney disease. The ineffectiveness of enzyme replacement therapy (ERT) for severe kidney failure highlights the need for early detection and meaningful markers. However, because the diagnosis and treatment of Fabry disease can vary according to the expertise of physicians, we evaluated the opinions of Korean specialists. METHODS A questionnaire regarding the management of Fabry nephropathy was emailed to healthcare providers with the experience or ability to treat individuals with Fabry nephropathy. RESULTS Of the 70 experts who responded to the survey, 43 were nephrologists, and 64.3% of the respondents reported having treated patients with Fabry disease. Pediatricians are treating primarily patients with classic types of the disease, while nephrologists and cardiologists are treating more patients with variant types. Only 40.7% of non-nephrologists agreed that a kidney biopsy was required at the time of diagnosis, compared with 81.4% of nephrologists. Thirty-eight of 70 respondents (54.3%) reported measuring globotriaosylsphingosine (lyso-Gb3) as a biomarker. The most common period to measure lyso-Gb3 was at the time of diagnosis, followed by after ERT, before ERT, and at screening. For the stage at which ERT should begin, microalbuminuria and proteinuria were chosen by 51.8% and 28.6% of respondents, respectively. CONCLUSION Nephrologists are more likely to treat variant Fabry disease rather than classic cases, and they agree that ERT should be initiated early in Fabry nephropathy, using lyso-Gb3 as a biomarker.
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Affiliation(s)
- Soo Jeong Choi
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Su Hyun Kim
- Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea
| | - Min Sung Lee
- Department of Internal Medicine, Ewha Womans University Medical Center, Seoul, Republic of Korea
| | - Samel Park
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Eunjung Cho
- Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Kore
| | - Eun Sil Koh
- Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung Ha Chung
- Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung Hwan Jeong
- Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Eun Young Lee
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Young Joo Kwon
- Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Whitlock RH, Nour-Mohammadi M, Curtis S, Komenda P, Bohm C, Collister D, Tangri N, Rigatto C. Magnitude of the Potential Screening Gap for Fabry Disease in
Manitoba: A Population-Based Retrospective Cohort Study. Can J Kidney Health Dis 2023; 10:20543581231162218. [PMID: 36970566 PMCID: PMC10031591 DOI: 10.1177/20543581231162218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/28/2023] [Indexed: 03/24/2023] Open
Abstract
Background: Fabry disease is a rare disorder caused by the deficient activity of
α-galactosidase A (GLA) that often leads to organ damage. Fabry disease can
be treated with enzyme replacement or pharmacological therapy, but due to
its rarity and nonspecific manifestations, it often goes undiagnosed. Mass
screening for Fabry disease is impractical; however, a targeted screening
program for high-risk individuals may uncover previously unknown cases. Objective: Our objective was to use population-level administrative health databases to
identify patients at high risk of Fabry disease. Design: Retrospective cohort study. Setting: Population-level health administrative databases housed at the Manitoba
Centre for Health Policy. Patients: All residents of Manitoba, Canada, between 1998 and 2018. Measurements: We ascertained the evidence of GLA testing in a cohort of patients at high
risk of Fabry disease. Methods: Individuals without a hospitalization or prescription indicative of Fabry
disease were included if they had evidence of 1 of 4 high-risk conditions
for Fabry disease: (1) ischemic stroke <45 years of age, (2) idiopathic
hypertrophic cardiomyopathy, (3) proteinuric chronic kidney disease or
kidney failure of unknown cause, or (4) peripheral neuropathy. Patients were
excluded if they had known contributing factors to these high-risk
conditions. Those who remained and had no prior GLA testing were assigned a
0% to 4.2% probability of having Fabry disease depending on their high-risk
condition and sex. Results: After applying exclusion criteria, 1386 individuals were identified as having
at least 1 high-risk clinical condition for Fabry disease in Manitoba. There
were 416 GLA tests conducted during the study period, and of those, 22 were
conducted in individuals with at least 1 high-risk condition. This leaves a
screening gap of 1364 individuals with a high-risk clinical condition for
Fabry disease in Manitoba who have not been tested. At the end of the study
period, 932 of those individuals were still alive and residing in Manitoba,
and if screened today, we expect between 3 and 18 would test positive for
Fabry disease. Limitations: The algorithms we used to identify our patients have not been validated
elsewhere. Diagnoses of Fabry disease, idiopathic hypertrophic
cardiomyopathy, and peripheral neuropathy were only available via
hospitalizations and not physician claims. We were only able to capture GLA
testing processed through public laboratories. Patients identified to be at
high risk of Fabry disease by the algorithm did not undergo GLA testing due
to a clinical rationale that we were unable to capture. Conclusions: Administrative health databases may be a useful tool to identify patients at
higher risk of Fabry disease or other rare conditions. Further directions
include designing a program to screen high-risk individuals for Fabry
disease as identified by our administrative data algorithms.
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Affiliation(s)
- Reid H. Whitlock
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
- Reid H. Whitlock, Chronic Disease
Innovation Centre, Seven Oaks General Hospital, 2LB19-2300 McPhillips Street,
Winnipeg, MB R2V 3M3, Canada.
| | - Mohammad Nour-Mohammadi
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
- Department of Internal Medicine,
University of Manitoba, Winnipeg, Canada
| | - Sarah Curtis
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Paul Komenda
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
- Department of Internal Medicine,
University of Manitoba, Winnipeg, Canada
| | - Clara Bohm
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
- Department of Internal Medicine,
University of Manitoba, Winnipeg, Canada
| | - David Collister
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
- Department of Medicine, University of
Alberta, Edmonton, Canada
| | - Navdeep Tangri
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
- Department of Internal Medicine,
University of Manitoba, Winnipeg, Canada
| | - Claudio Rigatto
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
- Department of Internal Medicine,
University of Manitoba, Winnipeg, Canada
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The Spanish Fabry women study: a retrospective observational study describing the phenotype of females with GLA variants. Orphanet J Rare Dis 2023; 18:8. [PMID: 36624527 PMCID: PMC9830917 DOI: 10.1186/s13023-022-02599-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Fabry disease (FD) is an X-linked condition caused by variants in the GLA gene. Since females have two X chromosomes, they were historically thought to be carriers. Although increased knowledge has shown that females often develop the disease, data from Spain and other countries reported that females were undertreated. The aim of this study was to provide a wider and more recent description of the disease characteristics and associated management of females with a GLA variant in a Spanish cohort. RESULTS Ninety-seven females from 12 hospitals were included in this retrospective study. Mean age was 50.1 ± 17.2 years. Median follow-up time from GLA variant identification was 36.1 months, and most (70.1%) were identified through family screening. Variants associated with classic/non-classic phenotypes were similarly distributed (40.2%/53.6%). Missense variants were the most prevalent (n = 84, 86.6%). In the overall group, 70.4% had major organ involvement (i.e., cardiac, renal, cerebrovascular, peripheral nervous system or gastrointestinal), and 47.3% also had typical Fabry signs (angiokeratoma, cornea verticillata or increased plasma lyso-Gb3). Cardiac involvement was the most prevalent (49.5%) and the main reason for treatment initiation. A total of 33 (34%) patients received disease-specific therapy, 55% of whom were diagnosed by family screening. Females carrying variants associated with a classic phenotype had higher frequencies of clinical manifestations (92.3%) and were predominant in the treated subgroup (69.7%). Despite this, there were 34 untreated females (56.7% of total untreated), with both phenotypes represented, who had major organ involvement, with 27 of cardiac, renal or cerebrovascular nature. Age or comorbidities in this subgroup were comparable to the treated subgroup (P = 0.8 and P = 0.8, respectively). CONCLUSIONS Efforts have been made in recent years to diagnose and treat timely Fabry females in Spain. A high percentage of females with pathogenic variants, regardless of their associated phenotype, will likely develop disease. A proportion of females with severe disease in this cohort received specific treatment. Still a significant number of females, even with same profile as the treated ones, who may be eligible for treatment according to European recommendations, remained untreated. Reasons for this merit further investigation.
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Palaiodimou L, Kokotis P, Zompola C, Papagiannopoulou G, Bakola E, Papadopoulou M, Zouvelou V, Petras D, Vlachopoulos C, Tsivgoulis G. Fabry Disease: Current and Novel Therapeutic Strategies. A Narrative Review. Curr Neuropharmacol 2023; 21:440-456. [PMID: 35652398 PMCID: PMC10207921 DOI: 10.2174/1570159x20666220601124117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/11/2022] [Accepted: 05/20/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Fabry disease (FD) is an inherited lysosomal storage disorder, leading to multisystemic manifestations and causing significant morbidity and mortality. OBJECTIVE The aim of this narrative review is to present the current and novel therapeutic strategies in FD, including symptomatic and specific treatment options. METHODS A systematic literature search was conducted to identify relevant studies, including completed and ongoing randomized-controlled clinical trials (RCTs), prospective or retrospective cohort studies, case series and case reports that provided clinical data regarding FD treatment. RESULTS A multidisciplinary symptomatic treatment is recommended for FD patients, personalized according to disease manifestations and their severity. During the last two decades, FD-specific treatments, including two enzyme-replacement-therapies (agalsidase alfa and agalsidase beta) and chaperone treatment with migalastat have been approved for use and allowed for symptoms' stabilization or even disease burden reduction. More therapeutic agents are currently under investigation. Substrate reduction therapies, including lucerastat and venglustat, have shown promising results in RCTs and may be used either as monotherapy or as complementary therapy to established enzymereplacement- therapies. More stable enzyme-replacement-therapy molecules that are associated with less adverse events and lower likelihood of neutralizing antibodies formation have also been developed. Ex-vivo and in-vivo gene therapy is being tested in animal models and pilot human clinical trials, with preliminary results showing a favorable safety and efficacy profile. CONCLUSION The therapeutic landscape in FD appears to be actively expanding with more treatment options expected to become available in the near future, allowing for a more personalized approach in FD patients.
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Affiliation(s)
- Lina Palaiodimou
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Kokotis
- First Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, Athens, Greece
| | - Christina Zompola
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Papagiannopoulou
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Bakola
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianna Papadopoulou
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki Zouvelou
- First Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, Athens, Greece
| | - Dimitrios Petras
- Nephrology Department, Hippokration General Hospital, Athens, Greece
| | | | - Georgios Tsivgoulis
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
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Koto Y, Yamashita W, Lee Y, Hadano N, Kokubu C, Sakai N. Development and validation of a disease-specific quality of life scale for adult patients with Fabry disease in Japan. J Patient Rep Outcomes 2022; 6:115. [DOI: 10.1186/s41687-022-00525-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
Fabry disease is a rare X-linked lysosomal storage disorder. It is associated with physical distress and social challenges that may affect adults differently compared to pediatric patients. However, there is no disease-specific quality of life (QOL) scale that can provide a detailed assessment of QOL for adults with Fabry disease. Therefore, we aimed to determine the factor structure and assess the validity of a scale that was created to assess the QOL of adult patients with Fabry disease. This study was conducted in two phases. First, scale feasibility was confirmed through a questionnaire survey of nine patients. Second, a cross-sectional questionnaire survey of patients (aged ≥ 18 years) diagnosed with Fabry disease was conducted. Item development and refinement were conducted based on guidelines for scale development. Exploratory factor analysis was used to clarify the factor structure and confirm internal consistency. As a measure of QOL, construct validity was of the scale was verified based on its correlations with the Short Form-8 (SF-8) scale.
Results
The newly created Adult Fabry Disease QOL (AFQOL) scale comprises 39 items that cover five factors: “neuropathic pain and abdominal symptoms,” “impact on work and school,” “relationship challenges,” “ophthalmologic and otolaryngologic symptoms,” and “cardiovascular and renal symptoms.” Cronbach’s alpha coefficient for all factors was above 0.8, and the AFQOL total scores were significantly correlated with the physical and mental components of the SF-8 (rs = − 0.508 and − 0.400, respectively).
Conclusions
The AFQOL scale assesses physical symptoms and social difficulties experienced by adult patients with Fabry disease. A strength of the scale is its ability to assess the impact of work and relationships on patients. The scale can be useful in objectively assessing QOL for a group or for individual patients. Future research should explore further aspects of the scale’s validity and reliability.
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Kis M, Dogan Y, Yildirim A, Güzel T, Bekar L, Akhan O, Dogdus M, Harbalıoğlu H, Karabulut D, Soydan E, Zoghi M, Ergene O. Evaluation of demographic, clinical, and aetiological data of patients admitted to cardiology clinics and diagnosed with left ventricular hypertrophy in Turkish population (LVH-TR). Acta Cardiol 2022; 77:836-845. [PMID: 36222672 DOI: 10.1080/00015385.2022.2119670] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is potentially modifiable cardiovascular risk factor often overlooked in clinical practice. For this reason, we planned to LVH-TR (Left Ventricular Hypertrophy in Turkish Population) trial to determine the aetiological causes and demographic characteristics of LVH patients. METHODS Our study was a multicentre, national, observational study and included 886 patients who applied to the cardiology clinics in 22 centres between February 2020 and August 2021. In the initial evaluation, the Fabry disease (FD) and cardiac amyloidosis (CA) algorithm was followed in patients whose definitive etiologic cause(s) could not be identified. RESULTS The most common aetiological causes of LVH in our study were hypertension with a rate of 56.6%, heart valve disease with 8.2%, and hypertrophic cardiomyopathy with 7.5%. Athlete's heart was detected in eight patients, LV non-compaction was detected in four patients. The rate of LVH of unknown cause was 18.8%. FD was suspected in 143 patients, and CA was suspected in 16 patients. There were 43 (4.85%) patients with low α-galactosidase A enzyme levels. GLA gene mutation analysis was positive in 1.58% of all patients, and these patients were diagnosed with FD, and 15 (1.69%) patients were diagnosed with CA by endomyocardial biopsy method. CONCLUSION In the aetiology of LVH, the rate of LVH of unknown cause was high. FD and CA should be considered primarily in this patient group. Early diagnosis of the disease by following the schemes leading to FD and CA was essential in starting treatment before the progression of the disease.
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Affiliation(s)
- Mehmet Kis
- Department of Cardiology, Dokuz Eylul University, Izmir, Turkey
| | - Yasemin Dogan
- Department of Cardiology, Kayseri City Hospital, Kayseri, Turkey
| | - Abdullah Yildirim
- Department of Cardiology, Adana City Training and Research Hospital, Adana, Turkey
| | - Tuncay Güzel
- Department of Cardiology, Akhisar State Hospital, Manisa, Turkey
| | - Lutfu Bekar
- Department of Cardiology, Hitit University Faculty of Medicine, Corum, Turkey
| | - Onur Akhan
- Department of Cardiology, Bilecik State Hospital, Bilecik, Turkey
| | - Mustafa Dogdus
- Department of Cardiology, Usak University Training and Research Hospital, Usak, Turkey
| | - Hazar Harbalıoğlu
- Department of Cardiology, Düzce Atatürk State Hospital, Duzce, Turkey
| | - Dilay Karabulut
- Department of Cardiology, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Elton Soydan
- Department of Cardiology, EGE University, Izmir, Turkey
| | - Mehdi Zoghi
- Department of Cardiology, EGE University, Izmir, Turkey
| | - Oktay Ergene
- Department of Cardiology, Dokuz Eylul University, Izmir, Turkey
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Lenzini L, Carraro G, Avogaro A, Vitturi N. Genetic Diagnosis in a Cohort of Adult Patients with Inherited Metabolic Diseases: A Single-Center Experience. Biomolecules 2022; 12:biom12070920. [PMID: 35883476 PMCID: PMC9312969 DOI: 10.3390/biom12070920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Inherited metabolic diseases (IMDs) are genetic conditions that result in metabolism alterations. Although research-based Next Generation Sequencing (NGS) testing for IMD has been recently implemented, its application in a clinical diagnostic setting remains challenging. Thus, we aimed at investigating the genetic diagnostic approach in a cohort of adult patients with IMDs referred to our adult metabolic unit. A retrospective analysis was performed collecting demographic, clinical, and genetic data of patients referred to the Adult Metabolic Unit in Padua from November 2017 to March 2022. In total, 108 adult patients (mean age: 33 years ± 17, 55% women) were enrolled in the study, and 83 (77%) of the patients transitioned from the pediatric metabolic clinics. The most prevalent groups of IMDs were disorders of complex molecule degradation (32 patients) and disorders of amino acid metabolism (31) followed by disorders of carbohydrates (26). Molecular genetic diagnosis was reported by 69 (64%) patients, with the higher rate reported by patients referred from specialty other than pediatric (88% vs. 55%). Almost all the subjects (92%) with disorders of complex molecule degradation had a genetic diagnosis. Patients with disorders of amino acid metabolism and disorders of carbohydrates had almost the same rate of genetic test (39% and 38%, respectively). Among the patients without a genetic diagnosis that we tested, two novel mutations in disease-associated genes were detected. In our single-center cohort, a consistent proportion (36%) of subjects with IMDs reaches the adulthood without a genetic demonstration of the disease. This lack, even if in some cases could be related to disease-specific diagnostic approach or to different disease onset, could be detrimental to patient management and impact to some of the specific needs of adult subjects.
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Affiliation(s)
- Livia Lenzini
- Department of Medicine-DIMED, University Hospital, University of Padova, 35128 Padova, Italy;
| | - Gianni Carraro
- Nephrology, Dialysis and Transplant Unit, Department of Medicine-DIMED, University Hospital, University of Padova, 35128 Padova, Italy;
| | - Angelo Avogaro
- Division of Metabolic Diseases, Department of Medicine-DIMED, University Hospital, University of Padova, 35128 Padova, Italy;
| | - Nicola Vitturi
- Division of Metabolic Diseases, Department of Medicine-DIMED, University Hospital, University of Padova, 35128 Padova, Italy;
- Correspondence: ; Tel.: +39-049-821-4326
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Monte MA, Veroux M, Rodolico MS, Losi V, Di Pino L, Bella R, Lanza G, Monte IP. Fabry's Disease: The Utility of a Multidisciplinary Screening Approach. Life (Basel) 2022; 12:life12050623. [PMID: 35629291 PMCID: PMC9146284 DOI: 10.3390/life12050623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/10/2022] [Accepted: 04/20/2022] [Indexed: 02/07/2023] Open
Abstract
(1) Background: As a lysosomal storage disorder, Fabry’s disease (FD) shows variable clinical manifestations. We applied our multidisciplinary approach to identify any organ damage in a sample of adult patients with different pathogenic variants. (2) Methods: 49 participants (mean age 44.3 ± 14.2 years; 37 females), underwent a multidimensional clinical and instrumental assessment. (3) Results: At diagnosis, mean enzymatic activity was 5.2 ± 4.6 nM/mL/h in females and 1.4 ± 0.5 nM/mL/h in males (normal values > 3.0), whereas globotriaosylsphingosine was 2.3 ± 2.1 nM/L in females and 28.7 ± 3.5 nM/L in males (normal values < 2.0). Overall, cardiovascular, neurological, and audiological systems were the most involved, regardless of the variant detected. Patients with classic variants (10) showed typical multiorgan involvement and, in some cases, prevalent organ damage (cardiovascular, neurological, renal, and ocular). Those with late-onset variants (39) exhibited lower occurrence of multiorgan impairment, although some of them affected the cardiovascular and neurological systems more. In patients with lower enzymatic activity, the most frequent involvement was neurological, followed by peripheral vascular disease. (4) Conclusions: FD patients exhibited wide phenotypic variability, even at single-organ level, likely due to the individual genetic mutation, although other factors may contribute. Compared to the conventional management, a multidisciplinary approach, as that prompted at our Center, allows one to achieve early clinical detection and management.
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Affiliation(s)
- Marco Angelo Monte
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (M.A.M.); (V.L.); (L.D.P.); (G.L.)
| | - Massimiliano Veroux
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (M.V.); (R.B.)
| | | | - Valentina Losi
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (M.A.M.); (V.L.); (L.D.P.); (G.L.)
| | - Luigi Di Pino
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (M.A.M.); (V.L.); (L.D.P.); (G.L.)
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (M.V.); (R.B.)
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (M.A.M.); (V.L.); (L.D.P.); (G.L.)
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy
| | - Ines Paola Monte
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (M.A.M.); (V.L.); (L.D.P.); (G.L.)
- Correspondence:
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14
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Ezgu F, Alpsoy E, Bicik Bahcebasi Z, Kasapcopur O, Palamar M, Onay H, Ozdemir BH, Topcuoglu MA, Tufekcioglu O. Expert opinion on the recognition, diagnosis and management of children and adults with Fabry disease: a multidisciplinary Turkey perspective. Orphanet J Rare Dis 2022; 17:90. [PMID: 35236382 PMCID: PMC8889663 DOI: 10.1186/s13023-022-02215-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 02/06/2022] [Indexed: 11/10/2022] Open
Abstract
This consensus statement by a panel of Fabry experts aimed to identify areas of consensus on conceptual, clinical and therapeutic aspects of Fabry disease (FD) and to provide guidance to healthcare providers on best practice in the management of pediatric and adult patients with FD. This consensus statement indicated the clinical heterogeneity of FD as well as a large number of pathogenic variants in the GLA gene, emphasizing a need for an individualized approach to patient care. The experts reached consensus on the critical role of a high index of suspicion in symptomatic patients and screening of certain at-risk groups to reveal timely and accurate diagnosis of FD along with an increased awareness of the treating physician about the different kinds of pathogenic variants and their clinical implications. The experts emphasized the crucial role of timely recognition of FD with minimal delay from symptom onset to definite diagnosis in better management of FD patients, given the likelihood of changing the disease's natural history, improving the patients' quality of life and the prognosis after enzyme replacement therapy (ERT) administered through a coordinated, multidisciplinary care approach. In this regard, this consensus document is expected to increase awareness among physicians about unique characteristics of FD to assist clinicians in recognizing FD with a well-established clinical suspicion consistent with pathogenic variants and gender-based heterogeneous clinical manifestations of FD and in translating this information into their clinical practice for best practice in the management of patients with FD.
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Affiliation(s)
- Fatih Ezgu
- Department of Pediatrics, Division of Pediatric Metabolism and Division of Pediatric Genetics, Gazi University Faculty of Medicine, 06560, Ankara, Turkey.
| | - Erkan Alpsoy
- Department of Dermatology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Zerrin Bicik Bahcebasi
- Clinic of Nephrology, Kartal Dr. Lutfu Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Kasapcopur
- Department of Pediatrics, Division of Pediatric Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Melis Palamar
- Department of Ophthalmology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Huseyin Onay
- Department of Medical Genetics, Ege University Faculty of Medicine, Izmir, Turkey
| | | | | | - Omac Tufekcioglu
- University of Health Sciences Department of Cardiology, Ankara City Hospital, Ankara, Turkey
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15
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Silva CAB, Andrade LGMD, Vaisbich MH, Barreto FDC. Brazilian consensus recommendations for the diagnosis, screening, and treatment of individuals with fabry disease: Committee for Rare Diseases - Brazilian Society of Nephrology/2021. J Bras Nefrol 2022; 44:249-267. [PMID: 35212703 PMCID: PMC9269181 DOI: 10.1590/2175-8239-jbn-2021-0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/16/2021] [Indexed: 11/21/2022] Open
Abstract
Fabry disease (FD) is an X-linked inherited disorder caused by mutations in the GLA gene encoding enzyme alpha-galactosidase A (α-Gal A). The purpose of this study was to produce a consensus statement to standardize the recommendations concerning kidney involvement in FD and provide advice on the diagnosis, screening, and treatment of adult and pediatric patients. This consensus document was organized from an initiative led by the Committee for Rare Diseases (Comdora) of the Brazilian Society of Nephrology (SBN). The review considered randomized clinical trials, real-world data studies, and the expertise of its authors. The purpose of this consensus statement is to help manage patient and physician expectations concerning the outcomes of treatment. Our recommendations must be interpreted within the context of available evidence. The decisions pertaining to each individual case must be made with the involvement of patients and their families and take into account not only the potential cost of treatment, but also concurrent conditions and personal preferences. The Comdora intends to update these recommendations regularly so as to reflect recent literature evidence, real-world data, and appreciate the professional experience of those involved. This consensus document establishes clear criteria for the diagnosis of FD and for when to start or stop specific therapies or adjuvant measures, to thus advise the medical community and standardize clinical practice.
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16
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Yanık Ö, Çıkı K, Özmert E, Sivri S. Vascular and structural analyses of retinal and choroidal alterations in Fabry disease: the effect of hyperreflective foci and retinal vascular tortuosity. Ophthalmic Genet 2022; 43:344-353. [PMID: 35038962 DOI: 10.1080/13816810.2022.2025607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the effects of Fabry disease (FD) on the retinal microvasculature and choroidal vascular and structural characteristics. METHODS This study included 10 patients with FD and 10 age-matched healthy controls. Binarized enhanced depth imaging optical coherence tomography (OCT) images were used to measure the total choroidal area, luminal area, and stromal area with ImageJ software. The choroidal vascularity index (CVI) was assessed. The vessel densities (VD) of the retinal capillary plexuses and foveal avascular zone (FAZ) area were measured with OCT-angiography. RESULTS The most common anterior segment finding was cornea verticillata (60.0%) and the most frequent posterior segment finding was vascular tortuosity (50.0%). Intraretinal hyperreflective foci on B-scan OCT was observed in 50.0% of the cases. In Fabry cases, a linear mixed model with random intercept revealed that 1% change in CVI was related to -0.009 mm2 (p = .015) change in FAZ area and -0.047 mm change, (p = .024) in FAZ perimeter. In the presence of retinal vascular tortuosity, 1% change in CVI was related to -0.013 mm2 (p = .002) change in FAZ area and -0.052 mm change (p = .004) in FAZ perimeter. In the presence of hyperreflective foci, 1% change in CVI was related to -0.014 mm2 (p = .004) change in FAZ area and -0.064 mm change (p = .003) in FAZ perimeter. CONCLUSION The significant negative associations between FAZ measurements and CVI suggest a possible interaction between the choroidal and retinal microvasculature of patients with FD. These alterations were more pronounced in the presence of hyperreflective foci and retinal vascular tortuosity.
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Affiliation(s)
- Özge Yanık
- Department of Ophthalmology, Ankara University School of Medicine, Ankara, Turkey
| | - Kismet Çıkı
- Department of Pediatric Metabolism and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Emin Özmert
- Department of Ophthalmology, Ankara University School of Medicine, Ankara, Turkey
| | - Serap Sivri
- Department of Pediatric Metabolism and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
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17
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A new approach to identifying patients with elevated risk for Fabry disease using a machine learning algorithm. Orphanet J Rare Dis 2021; 16:518. [PMID: 34930374 PMCID: PMC8686369 DOI: 10.1186/s13023-021-02150-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022] Open
Abstract
Background Fabry disease (FD) is a rare genetic disorder characterized by glycosphingolipid accumulation and progressive damage across multiple organ systems. Due to its heterogeneous presentation, the condition is likely significantly underdiagnosed. Several approaches, including provider education efforts and newborn screening, have attempted to address underdiagnosis of FD across the age spectrum, with limited success. Artificial intelligence (AI) methods present another option for improving diagnosis. These methods isolate common health history patterns among patients using longitudinal real-world data, and can be particularly useful when patients experience nonspecific, heterogeneous symptoms over time. In this study, the performance of an AI tool in identifying patients with FD was analyzed. The tool was calibrated using de-identified health record data from a large cohort of nearly 5000 FD patients, and extracted phenotypic patterns from these records. The tool then used this FD pattern information to make individual-level estimates of FD in a testing dataset. Patterns were reviewed and confirmed with medical experts. Results The AI tool demonstrated strong analytic performance in identifying FD patients. In out-of-sample testing, it achieved an area under the receiver operating characteristic curve (AUROC) of 0.82. Strong performance was maintained when testing on male-only and female-only cohorts, with AUROCs of 0.83 and 0.82 respectively. The tool identified small segments of the population with greatly increased prevalence of FD: in the 1% of the population identified by the tool as at highest risk, FD was 23.9 times more prevalent than in the population overall. The AI algorithm used hundreds of phenotypic signals to make predictions and included both familiar symptoms associated with FD (e.g. renal manifestations) as well as less well-studied characteristics. Conclusions The AI tool analyzed in this study performed very well in identifying Fabry disease patients using structured medical history data. Performance was maintained in all-male and all-female cohorts, and the phenotypic manifestations of FD highlighted by the tool were reviewed and confirmed by clinical experts in the condition. The platform’s analytic performance, transparency, and ability to generate predictions based on existing real-world health data may allow it to contribute to reducing persistent underdiagnosis of Fabry disease.
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18
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Tang ASO, Wong QY, Pao Lin Ting I, Selvesten P, Yeo ST, Chew LP, Fam TL, Tan CHH. First 2 Fabry Cases with Novel Mutation and Their Associated Clusters in Malaysia. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932923. [PMID: 34354036 PMCID: PMC8351246 DOI: 10.12659/ajcr.932923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND No cases of Fabry disease (FD) have been reported thus far in Malaysia. We aimed to report the demographic characteristics, clinical manifestations, molecular results, and treatment outcomes of 2 FD cases. This study was a retrospective review of 2 family clusters of FD on follow-up in Sarawak, Malaysia. CASE REPORT Two index patients were confirmed to have FD. Index patient 1, who had nephrotic-range proteinuria and cornea verticillata, carried a variant within exon 4 of the GLA gene: c.610 T>C (p.Trp204Arg). Agalsidase beta (Fabrazyme®) enzyme replacement therapy was initiated, with the absence of neutralizing antibody after 24 months. No hypersensitivity or adverse reactions were reported. The patient's proteinuria and renal function remained stable. Other family members who carried the same mutation were asymptomatic. Index patient 2, who had residual activity of alpha-galactosidase A and a normal globotriaosylsphingosine level, carried a novel GLA mutation of c.548-5T>A. He was diagnosed with end-stage renal disease on regular dialysis and had nonspecific headache with 1 episode of seizure a few years prior to FD genetic screening. One brother had chronic neuropathic pain but refused further investigations. Other family members who had the same mutation were asymptomatic. This mutation has never been reported in literature, and its pathogenicity warrants further studies. CONCLUSIONS It is of utmost importance to increase awareness of FD among clinicians, so that appropriate screening may be done to determine its true prevalence and prompt treatment can be initiated early.
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Affiliation(s)
- Andy Sing Ong Tang
- Department of Internal Medicine, Miri Hospital, Ministry of Health, Miri, Sarawak, Malaysia
| | - Qi Ying Wong
- Department of Internal Medicine, Miri Hospital, Ministry of Health, Miri, Sarawak, Malaysia
| | - Ingrid Pao Lin Ting
- Department of Internal Medicine, Miri Hospital, Ministry of Health, Miri, Sarawak, Malaysia
| | - Panting Selvesten
- Department of Internal Medicine, Miri Hospital, Ministry of Health, Miri, Sarawak, Malaysia
| | - Siaw Tze Yeo
- Department of Internal Medicine, Miri Hospital, Ministry of Health, Miri, Sarawak, Malaysia
| | - Lee Ping Chew
- Haematology Unit, Department of Internal Medicine, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia
| | - Tem Lom Fam
- Department of Internal Medicine, Miri Hospital, Ministry of Health, Miri, Sarawak, Malaysia
| | - Clare Hui Hong Tan
- Nephrology Unit, Department of Internal Medicine, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia
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Rullo L, Posa L, Caputi FF, Stamatakos S, Formaggio F, Caprini M, Liguori R, Candeletti S, Romualdi P. Nociceptive behavior and central neuropeptidergic dysregulations in male and female mice of a Fabry disease animal model. Brain Res Bull 2021; 175:158-167. [PMID: 34339779 DOI: 10.1016/j.brainresbull.2021.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/16/2021] [Accepted: 07/26/2021] [Indexed: 01/22/2023]
Abstract
Fabry disease (FD) is an X-linked inherited disorder characterized by glycosphingolipid accumulation due to deficiency of α-galactosidase A (α-Gal A) enzyme. Chronic pain and mood disorders frequently coexist in FD clinical setting, however underlying pathophysiologic mechanisms are still unclear. Here we investigated the mechanical and thermal sensitivity in α-Gal A (-/0) hemizygous male and the α-Gal A (-/-) homozygous female mice. We also characterized the gene expression of dynorphinergic, nociceptinergic and CRFergic systems, known to be involved in pain control and mood disorders, in the prefrontal cortex, amygdala and thalamus of α-Gal A (-/0) hemizygous male and the α-Gal A (-/-) homozygous female mice. Moreover, KOP receptor protein levels were evaluated in the same areas. Fabry knock-out male, but not female, mice displayed a decreased pain threshold in both mechanical and thermal tests compared to their wild type littermates. In the amygdala and prefrontal cortex, we observed a decrease of pDYN mRNA levels in males, whereas an increase was assessed in females, thus suggesting sex-related dysregulation of stress coping and pain mechanisms. Elevated mRNA levels for pDYN/KOP and CRF/CRFR1 systems were observed in male and female thalamus, a critical crossroad for both painful signals and cognitive/emotional processes. KOP receptor protein level changes assessed in the investigated areas, appeared mostly in agreement with KOP gene expression alterations. Our data suggest that α-Gal A enzyme deficiency in male and female mice is associated with distinct neuropeptide gene and protein expression dysregulations of investigated systems, possibly related to the neuroplasticity underlying the neurological features of FD.
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Affiliation(s)
- Laura Rullo
- Dept. of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum - University of Bologna, Via Irnerio 48, Bologna, 40126, Italy
| | - Luca Posa
- Dept. of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum - University of Bologna, Via Irnerio 48, Bologna, 40126, Italy; Neurobiological Psychiatry Unit, Department of Psychiatry, McGill University, Montreal, QC, Canada; Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
| | - Francesca Felicia Caputi
- Dept. of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum - University of Bologna, Via Irnerio 48, Bologna, 40126, Italy
| | - Serena Stamatakos
- Dept. of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum - University of Bologna, Via Irnerio 48, Bologna, 40126, Italy
| | - Francesco Formaggio
- Dept. of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum - University of Bologna, Via Irnerio 48, Bologna, 40126, Italy
| | - Marco Caprini
- Dept. of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum - University of Bologna, Via Irnerio 48, Bologna, 40126, Italy
| | - Rocco Liguori
- IRCCS Institute of Neurological Sciences, Bologna, Italy; Dept. of Biomedical and Neuromotor Sciences (DiBiNeM), Alma Mater Studiorum - University of Bologna, Via Altura 3, Bologna, 40139, Italy
| | - Sanzio Candeletti
- Dept. of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum - University of Bologna, Via Irnerio 48, Bologna, 40126, Italy
| | - Patrizia Romualdi
- Dept. of Pharmacy and Biotechnology (FaBiT), Alma Mater Studiorum - University of Bologna, Via Irnerio 48, Bologna, 40126, Italy.
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Ali N, Caceres A, Hall EW, Laney D. Attention Deficits and ADHD Symptoms in Adults with Fabry Disease-A Pilot Investigation. J Clin Med 2021; 10:jcm10153367. [PMID: 34362157 PMCID: PMC8347978 DOI: 10.3390/jcm10153367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 11/16/2022] Open
Abstract
The present pilot study examines subjective reported symptoms of attention-deficit/hyperactivity (AD/H) in adults with Fabry disease (FD) in comparison with existing normative control data. Existing data from 69 adults with FD via the Achenbach System of Empirically Based Assessment Adult Self-Report questionnaire were analyzed. The results demonstrated a higher prevalence of AD/H symptoms in adults with FD than in the general United States population, with a roughly equal endorsement of Inattention/Attention Deficit symptoms (AD), Hyperactivity-Impulsivity (H-I) symptoms, and Combined Inattention/hyperactivity-impulsivity (C) symptoms. No gender differences were observed. While all subjects endorsing H-I symptoms fell into the symptomatic range on the AD/H scale, only two-thirds of subjects endorsing AD did so. This suggests that attention difficulties with FD are not solely explained by ADHD. Adults with FD who endorsed the AD, H-I, and C symptoms were also more likely to report mean adaptive functioning difficulties. These findings support the growing literature regarding attention difficulties in adults with FD, as well as suggesting a previously unrecognized risk of AD/H symptoms. Future research involving the objective assessment of ADHD in adults with FD is recommended. When serving adults with FD clinically, healthcare professionals should address multiple areas of care, including physical, psychological, and cognitive arenas.
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Affiliation(s)
- Nadia Ali
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA;
- Correspondence:
| | | | - Eric W. Hall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | - Dawn Laney
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA;
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21
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Anderson-Fabry Disease: From Endothelial Dysfunction to Emerging Therapies. Adv Pharmacol Pharm Sci 2021; 2021:5548445. [PMID: 34095851 PMCID: PMC8137293 DOI: 10.1155/2021/5548445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/07/2021] [Indexed: 12/30/2022] Open
Abstract
The Anderson–Fabry disease is a rare, X-linked, multisystemic, progressive lysosomal storage disease caused by α-galactosidase A total or partial deficiency. The resulting syndrome is mainly characterized by early-onset autonomic neuropathy and life-threatening multiorgan involvement, including renal insufficiency, heart disease, and early stroke. The enzyme deficiency leads to tissue accumulation of the glycosphingolipid globotriaosylceramide and its analogues, but the mechanisms linking such accumulation to organ damage are only partially understood. In contrast, enzyme replacement and chaperone therapies are already fully available to patients and allow substantial amelioration of quality and quantity of life. Substrate reduction, messenger ribonucleic acid (mRNA)-based, and gene therapies are also on the horizon. In this review, the clinical scenario and molecular aspects of Anderson–Fabry disease are described, along with updates on disease mechanisms and emerging therapies.
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Regenbogen C, Braunisch MC, Schmaderer C, Heemann U. Fabry disease: what the cardiologist should consider in non-cardiac screening, diagnosis, and management-narrative review. Cardiovasc Diagn Ther 2021; 11:661-671. [PMID: 33968643 DOI: 10.21037/cdt-20-845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fabry disease (FD) is a rare X chromosomally transmitted lysosomal storage disorders with an absence or deficiency of the enzyme alpha-galactosidase. The deposition of globotriaosylceramide (Gb3) may cause damage to all organs, particularly brain, heart and kidney. While acroparaesthesia, hypo- or anhydrosis and diarrhoea are the main symptoms in childhood, cardiac involvement with left ventricular hypertrophy (LVH), renal insufficiency, diffuse pain attacks and apoplexy are the main symptoms in adulthood. Regular examinations are necessary to record organ involvement and its progression. A major challenge is therefore to make a diagnosis at an early disease stage. This is the only way that treatment can be started if there is an indication. If FD is suspected, alpha-galactosidase should be tested in male patients and genetic testing should be performed in females to confirm the diagnosis. Since 2001, enzyme replacement therapy (ERT) has been available as a causal therapy. In 2016, chaperone therapy with the drug Migalastat was approved in the European Union, which leads to stabilisation of the defective alpha-galactosidase. Studies on gene therapy to cure FD in phase I/II. This review summarizes which patient should be screened, how to confirm the diagnosis and which examinations should be performed in FD patients during the course of the disease.
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Affiliation(s)
- Claudia Regenbogen
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Matthias Christoph Braunisch
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Christoph Schmaderer
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Uwe Heemann
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
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Mattig I, Canaan-Kühl S, Tillmanns C, Knebel F. Progression of electrocardiogram changes in an untreated fabry disease: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab045. [PMID: 33738419 PMCID: PMC7954241 DOI: 10.1093/ehjcr/ytab045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/21/2020] [Accepted: 01/19/2021] [Indexed: 12/01/2022]
Abstract
Background Fabry disease (FD) is a rare lysosomal storage disorder with multiorgan manifestation and associated with an increased morbidity and mortality. Fabry cardiomyopathy includes left ventricular ‘hypertrophy’ (LVH), cardiac arrhythmias, and heart failure. We report a case of an untreated FD with characteristic findings in electrocardiogram (ECG) over a follow-up period of 10 years. Case summary A 53-year-old man with FD presented to our outpatient department. He suffered from symptomatic ventricular extrasystoles. Echocardiography detected LVH and reduced global longitudinal strain. Twelve years ago, first examination was conducted due to ventricular arrhythmias. Electrocardiogram showed a short PQ minus P-wave (PendQ) interval and negative T-waves. Over time, the number of leads with negative T-waves increased. Moreover, the echocardiography revealed a thickened left ventricular wall. Without any further examinations at that time, the patient was treated for arterial hypertension with proteinuria. Ten years after first symptoms appeared, FD was diagnosed utilizing cardiac magnetic resonance imaging and genetic tests. Hence, enzyme replacement therapy was initiated. Discussion The ECG is a fast diagnostic method and it may — even without additional organ manifestations — provide preliminary suspicion of FD. In particular, as shown in our case, a short PendQ and QT interval indicate FD. Over time, disease progression can be detected through ECG changes. T-waves correlate with an increasing LVH and a reduction in longitudinal function in echocardiographic examinations. Unexplained LVH must be followed by differential diagnosis. In case of confirmed FD, patients should be treated by multidisciplinary teams in experienced centres.
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Affiliation(s)
- Isabel Mattig
- Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Corresponding author. Tel: +49 30 450 613305, Fax: +49 30 450 7 513932,
| | - Sima Canaan-Kühl
- Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Fabry Zentrum, Zentrum für seltene Nierenerkrankungen (CeRKiD), Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | | | - Fabian Knebel
- Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Oudenarder Straße 16, 13347 Berlin, Germany
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
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Varela P, Carvalho G, Martin RP, Pesquero JB. Fabry disease: GLA deletion alters a canonical splice site in a family with neuropsychiatric manifestations. Metab Brain Dis 2021; 36:265-272. [PMID: 33156427 DOI: 10.1007/s11011-020-00640-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/30/2020] [Indexed: 11/26/2022]
Abstract
Fabry disease (FD) is a rare X-linked glycosphingolipidosis caused by mutations in GLA, a gene responsible for encoding α-galactosidase A, an enzyme required for degradation of glycosphingolipids, mainly globotriaosylceramide (Gb3) in all cells of the body. FD patients present a broad spectrum of clinical phenotype and many symptoms are shared with other diseases, making diagnosis challenging. Here we describe a novel GLA variant located in the 5' splice site of the intron 3, in four members of a family with neuropsychiatric symptoms. Analysis of the RNA showed the variant promotes alteration of the wild type donor site, affecting splicing and producing two aberrant transcripts. The functional characterization showed absence of enzymatic activity in cells expressing both transcripts, confirming their pathogenicity. The family presents mild signs of FD, as angiokeratoma, cornea verticillata, acroparesthesia, tinnitus, vertigo, as well as accumulation of plasma lyso-Gb3 and urinary Gb3. Interestingly, the man and two women present psychiatric symptoms, as depression or schizophrenia. Although psychiatric illnesses, especially depression, are frequently reported in patients with FD and studies have shown that the hippocampus is an affected brain structure in these patients, it is not clear whether the Gb3 accumulation in the brain is responsible for these symptoms or they are secondary. Therefore, new studies are needed to understand whether the accumulation of Gb3 could produce neuronal alterations leading to psychiatric symptoms.
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Affiliation(s)
- Patrícia Varela
- Center for Research and Molecular Diagnostic of Genetic Diseases - Department of Biophysics, Universidade Federal de São Paulo, Rua Pedro de Toledo, 669 - 9o andar, São Paulo, 04039-032, Brazil
| | - Gerson Carvalho
- Medical Genetics Unit, Hospital de Apoio de Brasília, Brasília, DF, Brazil
| | - Renan Paulo Martin
- Center for Research and Molecular Diagnostic of Genetic Diseases - Department of Biophysics, Universidade Federal de São Paulo, Rua Pedro de Toledo, 669 - 9o andar, São Paulo, 04039-032, Brazil
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - João Bosco Pesquero
- Center for Research and Molecular Diagnostic of Genetic Diseases - Department of Biophysics, Universidade Federal de São Paulo, Rua Pedro de Toledo, 669 - 9o andar, São Paulo, 04039-032, Brazil.
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Del Tredici K, Ludolph AC, Feldengut S, Jacob C, Reichmann H, Bohl JR, Braak H. Fabry Disease With Concomitant Lewy Body Disease. J Neuropathol Exp Neurol 2020; 79:378-392. [PMID: 32016321 PMCID: PMC7092358 DOI: 10.1093/jnen/nlz139] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 11/07/2019] [Accepted: 12/15/2019] [Indexed: 12/20/2022] Open
Abstract
Although Gaucher disease can be accompanied by Lewy pathology (LP) and extrapyramidal symptoms, it is unknown if LP exists in Fabry disease (FD), another progressive multisystem lysosomal storage disorder. We aimed to elucidate the distribution patterns of FD-related inclusions and LP in the brain of a 58-year-old cognitively unimpaired male FD patient suffering from predominant hypokinesia. Immunohistochemistry (CD77, α-synuclein, collagen IV) and neuropathological staging were performed on 100-µm sections. Tissue from the enteric or peripheral nervous system was unavailable. As controls, a second cognitively unimpaired 50-year-old male FD patient without LP or motor symptoms and 3 age-matched individuals were examined. Inclusion body pathology was semiquantitatively evaluated. Although Lewy neurites/bodies were not present in the 50-year-old individual or in controls, severe neuronal loss in the substantia nigra pars compacta and LP corresponding to neuropathological stage 4 of Parkinson disease was seen in the 58-year-old FD patient. Major cerebrovascular lesions and/or additional pathologies were absent in this individual. We conclude that Lewy body disease with parkinsonism can occur within the context of FD. Further studies determining the frequencies of both inclusion pathologies in large autopsy-controlled FD cohorts could help clarify the implications of both lesions for disease pathogenesis, potential spreading mechanisms, and therapeutic interventions.
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Affiliation(s)
- Kelly Del Tredici
- Clinical Neuroanatomy Section, Department of Neurology, Center for Biomedical Research, University of Ulm
| | | | - Simone Feldengut
- Clinical Neuroanatomy Section, Department of Neurology, Center for Biomedical Research, University of Ulm
| | - Christian Jacob
- Clinical Neuroanatomy Section, Department of Neurology, Center for Biomedical Research, University of Ulm.,Institute for Anatomy and Cell Biology, University of Ulm, Ulm
| | - Heinz Reichmann
- Department of Neurology, Dresden University of Technology, Dresden
| | - Jürgen R Bohl
- Institute of Neuropathology, University of Mainz, Mainz, Germany
| | - Heiko Braak
- Clinical Neuroanatomy Section, Department of Neurology, Center for Biomedical Research, University of Ulm
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Henderson N, Berry L, Laney DA. Fabry Disease practice resource: Focused revision. J Genet Couns 2020; 29:715-717. [DOI: 10.1002/jgc4.1318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Nadene Henderson
- Division of Medical Genetics UPMC Children’s Hospital of Pittsburgh Pittsburgh PA USA
| | - Lisa Berry
- Division of Human Genetics Cincinnati Children's Hospital Medical Center Cincinnati OH USA
| | - Dawn A. Laney
- Department of Human Genetics Emory School of Medicine Atlanta GA USA
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Michaud M, Mauhin W, Belmatoug N, Garnotel R, Bedreddine N, Catros F, Ancellin S, Lidove O, Gaches F. When and How to Diagnose Fabry Disease in Clinical Pratice. Am J Med Sci 2020; 360:641-649. [PMID: 32723516 DOI: 10.1016/j.amjms.2020.07.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/30/2020] [Accepted: 07/09/2020] [Indexed: 01/27/2023]
Abstract
Fabry disease is a frequent lysosomal storage disorder secondary to the deficiency of alpha-galactosidase A enzyme. This X-linked genetic disease realizes progressive and systemic manifestations that affect both male and female. Fabry disease may present as "classical", as "late-onset" or "non-classical" forms. Symptoms and organ involvements of classical Fabry disease are acral pain crisis, cornea verticillata, hypertrophic cardiomyopathy, stroke and chronic kidney disease with proteinuria. Other common symptoms are often poorly recognized, such as gastrointestinal or ear involvements. In classical Fabry disease, symptoms first appear during childhood or during teenage years in males, but later in females. Patients with non-classical or late-onset Fabry disease have delayed manifestations or a single-organ involvement. Diagnosis is therefore difficult when classical organ involvements are missing, in paucisymptomatic patients or in late-onset forms. Recognition of Fabry disease is important because effective treatments are available. They have to be prescribed early. In male, diagnosis is made with alpha-galactosidase A enzyme activity dosage in leukocyte, that is very low or null in classical forms and under 30 percent in late-onset forms. Diagnosis is more challenging in females who may express normal residual enzyme activity. Other plasmatic biomarkers, such as lyso-globotriaosylceramide are interesting, especially in females. In this review, we aimed to summarize main clinical manifestations of Fabry disease to know when to evoke Fabry disease and propose a practical diagnosis algorithm to know how to diagnose.
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Affiliation(s)
- Martin Michaud
- Department of Internal Medicine, Hopital Joseph Ducuing, Toulouse, France; Competence Center for Lysosomal Storage Diseases, Hopital Joseph Ducuing, Toulouse, France.
| | - Wladimir Mauhin
- Internal Medicine and Rheumatology Department, Diaconesses-Croix Saint Simon Hospital Group, Paris, France; Referral Center for Lysosomal Diseases, site Avron, Paris, France
| | - Nadia Belmatoug
- Department of Internal Medicine, University Hospital Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Clichy, France; Referral Center for Lysosomal Diseases, University Hospital Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Roselyne Garnotel
- Biochemistry Laboratory, American Memorial Hospital Reims, Reims, France
| | - Naiya Bedreddine
- Association des patients de la maladie de Fabry, Marsannay La Cote, France
| | - Florian Catros
- Department of Internal Medicine, Hopital Joseph Ducuing, Toulouse, France; Competence Center for Lysosomal Storage Diseases, Hopital Joseph Ducuing, Toulouse, France
| | - Sophie Ancellin
- Department of Internal Medicine, Hopital Joseph Ducuing, Toulouse, France; Competence Center for Lysosomal Storage Diseases, Hopital Joseph Ducuing, Toulouse, France
| | - Olivier Lidove
- Internal Medicine and Rheumatology Department, Diaconesses-Croix Saint Simon Hospital Group, Paris, France; Referral Center for Lysosomal Diseases, site Avron, Paris, France
| | - Francis Gaches
- Department of Internal Medicine, Hopital Joseph Ducuing, Toulouse, France; Competence Center for Lysosomal Storage Diseases, Hopital Joseph Ducuing, Toulouse, France
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Sezer O, Ceylaner S. Genetic Management Algorithm in High-Risk Fabry Disease Cases; Especially in Female Indexes with Mutations. Endocr Metab Immune Disord Drug Targets 2020; 21:324-337. [PMID: 32640971 DOI: 10.2174/1871530320666200708135826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Fabry Disease (FD, OMIM#301500) is a progressive, life-threatening, multisystemic, rare lysosomal storage disease. Today, approximately 1000 mutations are recorded in the Human Gene Mutation Database (www.hgmd.org) for GLA. Among the identified mutations, genetic variants of unknown significance (GVUS) and novel mutations cause problems in terms of diagnosis and treatment approach. METHODS In our study, 510 high-risk patients were enrolled. 229 out of 510 were Male (45%) (Mean age was 40.8 ±15.0) and 281 of were Female (55%) (Mean age was 39, 7±15.5). The definite diagnosis of the FD was confirmed by GLA gene sequence analysis. GLA mutation was found in 15 cases (3.4%). Family members of the relevant indexes were included in the screening programs according to the X-linked inheritance pattern. And then we conducted family screening on 74 family members of 15 index cases. Of those 74 cases, 39 had mutations (53%). In males, α-GalA activity and in both gender Lyso-Gb3 levels were measured and multisystem evaluation was performed in all cases with the mutation. RESULTS We found six different familial mutation types; two of them pathogenic; p.D170N (1), p.P205S (13), one of them GVUS; p.Q330R (1), three of them likely benign; p.D313Y (12), p.S126G (25), c.-30G>A (2) mutations were detected. CONCLUSION The purpose of this retrospective study is to approach Fabry disease on a genetic basis and to improve its management and to draw attention to the importance of early diagnosis. We also aimed to evaluate the appropriate algorithms to determine whether the mutation is the FD-causing mutation or not.
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Affiliation(s)
- Ozlem Sezer
- Department of Medical Genetics, Samsun Training and Research Hospital, Samsun, Turkey
| | - Serdar Ceylaner
- Department of Medical Genetics, Intergen Genetic Centre, Ankara, Turkey
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Hewavitharana H, Jasinge E, Abeysekera H, Wanigasinghe J. Cornea Verticillata in classical Fabry disease, first from Sri Lanka: a case report. BMC Pediatr 2020; 20:338. [PMID: 32641113 PMCID: PMC7341576 DOI: 10.1186/s12887-020-02237-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/02/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Fabry disease is a rare inborn error of metabolism with profound clinical consequences if untreated. It is caused by the deficiency of α galactosidase A enzyme and is the only lysosomal storage disorder with an X linked inheritance. Confirmation requires genetic analysis of Galactosidase Alpha (GLA) Gene, which is often a challenge in resource-poor settings. Despite these technological limitations, specific clinical features in this condition can establish the diagnosis. CASE PRESENTATION We report on a 13-year old male who presented with an afebrile convulsion with a background history of chronic burning sensation of hands and feet and anhidrosis for 2 years duration with a similar history of episodic acroparesthesia in the other male sibling. The early clinical diagnosis was based on the history and detection of Cornea Verticillata on eye examination. Biochemical confirmation was established with detection of low α galactosidase A enzyme levels and a missense mutation of the Galactosidase Alpha (GLA) Gene (c.136C > T) established the genetic confirmation. CONCLUSION This is the first case of Fabry disease reported in Sri Lanka. Awareness of specific clinical features aided clinical diagnosis long before access to genetic confirmation was available.
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Affiliation(s)
- Hasani Hewavitharana
- Professorial Paediatric Unit, Lady Ridgeway Hospital for Children, Colombo 08, Sri Lanka
| | - Eresha Jasinge
- Department of Chemical Pathology, Lady Ridgeway Hospital for Children, Colombo 08, Sri Lanka
| | - Hiranya Abeysekera
- Department of Paediatric Ophthalmology, Lady Ridgeway Hospital for Children, Colombo 08, Sri Lanka
| | - Jithangi Wanigasinghe
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo 8, Sri Lanka
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Vardarli I, Rischpler C, Herrmann K, Weidemann F. Diagnosis and Screening of Patients with Fabry Disease. Ther Clin Risk Manag 2020; 16:551-558. [PMID: 32606714 PMCID: PMC7319521 DOI: 10.2147/tcrm.s247814] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/09/2020] [Indexed: 12/30/2022] Open
Abstract
Fabry disease (FD) is an X-linked lysosomal storage disorder caused by absence or deficient activity of α-galactosidase A (α-Gal A) due to mutations in the α-galactosidase A gene (GLA), leading to progressive accumulation of globotriaosylceramide (Gb3) in tissues and organs including heart, kidney, the eyes, vascular endothelium, the nervous system and the skin. Cardiac involvement is leading to fatal complications and reduced life expectancy. FD is treatable with disease-specific treatment (enzyme replacement therapy (ERT) or with chaperone therapy). Therefore, the early diagnosis of FD is crucial for reducing the morbidity and mortality. Screening of high-risk populations (eg, patients with unexplained left ventricular hypertrophy (LVH), young patients with unexplained stroke, and patients with unexplained renal failure proteinuria or microalbuminuria) yields good results. The diagnostic algorithm is gender-specific. Initially, the measurement of α-Gal A activity is recommended in males, and optionally in females. In males with non-diagnostic residual activity (5–10%) activity, genetic testing is afterwards done for confirming the diagnosis. In fact, diagnosis of FD is not possible without genetic testing for both males and females. Globotriaosysphingosine (lyso-Gb3) for identification of atypical FD variants and high- sensitive troponin T (hsTNT) for identification of cardiac involvement are also important diagnostic biomarkers. The aim of this review was to provide an update on diagnosis and screening of patients with FD.
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Affiliation(s)
- Irfan Vardarli
- Department of Medicine I, Klinikum Vest, Knappschaftskrankenhaus Recklinghausen, Academic Teaching Hospital, Ruhr-University Bochum, Recklinghausen, Germany.,Herz- Und Gefäßzentrum Klinikum Vest, Recklinghausen, Germany
| | | | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Frank Weidemann
- Department of Medicine I, Klinikum Vest, Knappschaftskrankenhaus Recklinghausen, Academic Teaching Hospital, Ruhr-University Bochum, Recklinghausen, Germany.,Herz- Und Gefäßzentrum Klinikum Vest, Recklinghausen, Germany
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Serra W, Marziliano N. Role of cardiac imaging in Anderson-Fabry cardiomyopathy. Cardiovasc Ultrasound 2019; 17:1. [PMID: 30674321 PMCID: PMC6345038 DOI: 10.1186/s12947-019-0151-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/14/2019] [Indexed: 11/10/2022] Open
Abstract
The Anderson-Fabry disease (AFD, or simply Fabry Disease, FD; MIM #301500) is a rare X-linked lysosomal storage disorder (Xq22.1) characterized by progressive renal failure, leading to morbidity through cardio- and cerebro-vascular involvement. Despite the classic phenotype, only cardiac involvement (cardiac variant of AFD; MIM 301500) is frequent in about 40% of male and 28% of female AFD patients, as reported by the Fabry Registry (https://www.registrynxt.com). Morphologically, the cardiac characteristic of the disease, occurs as left ventricular hypertrophy, is accompanied by myocardial fibrosis. Cardiologists may come across these patients during clinical and instrumental evaluation in individuals with non-specific symptoms such as chest pain and arrhythmias, or after instrumental evidence of left ventricular hypertrophy/hypertrophic cardiomyopathy (HCM; MIM 192600). A comprehensive cardiological work-up, including a cardiological visit, a baseline electrocardiogram (ECG) and imaging by both echocardiography (ECHO) and magnetic resonance (MRI) enables identification of the cardiac involvement in patients with a proven diagnosis of AFD. The heart involvement is present in up to 75% of AFD patients irrespective of their sex. Involvement includes ECG and echocardiography features which suggest AFD and not HCM. Cardiac imaging plays an important role in detecting this sub-type of cardiomyopathy, which, since 2001, has benefited from the introduction of the enzyme replacement therapy (ERT) in symptomatic and pre-symptomatic patients.
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Affiliation(s)
- Walter Serra
- Cardiology Division, Surgery Department, University Hospital-Parma, Via Antonio Gramsci 14, 43100, Parma, IT, Italy.
| | - Nicola Marziliano
- University of Molise, Health Sciences Department-Campobasso, Campobasso, IT, Italy.,Fondazione Floresta Longo, Catania, IT, Italy
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Brito D, Cardim N, Lopes LR, Belo A, Mimoso J, Gonçalves L, Madeira H. Awareness of Fabry disease in cardiology: A gap to be filled. Rev Port Cardiol 2018; 37:457-466. [DOI: 10.1016/j.repc.2018.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/24/2018] [Accepted: 03/11/2018] [Indexed: 10/16/2022] Open
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Awareness of Fabry disease in cardiology: A gap to be filled. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Hongo K, Ito K, Date T, Anan I, Inoue Y, Morimoto S, Ogawa K, Kawai M, Kobayashi H, Kobayashi M, Ida H, Ohashi T, Taniguchi I, Yoshimura M, Eto Y. The beneficial effects of long-term enzyme replacement therapy on cardiac involvement in Japanese Fabry patients. Mol Genet Metab 2018; 124:143-151. [PMID: 29747997 DOI: 10.1016/j.ymgme.2018.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 04/21/2018] [Indexed: 01/02/2023]
Abstract
Fabry disease is a hereditary disorder that occurs due to the reduction or absence of alpha-galactosidase A activity, which leads to cardiac involvement including left ventricular hypertrophy (LVH). Enzyme replacement therapy (ERT) provides better patient outcomes by preventing serious complications. However, there have been very few studies on the long-term effects of ERT on the cardiac manifestations in Japanese Fabry patients. We retrospectively analyzed the data from the medical records of 42 Fabry patients (male, n = 17; female, n = 25) who were followed at Jikei University Hospital, and in whom the long-term effects of ERT could be evaluated (median follow-up period: male, 11 years; female, 8 years). The slope of the left ventricular mass (LVM) increase was 3.02 ± 3.41 g/m2/year in males and 1.69 ± 2.73 g/m2/year in females. In a subgroup analysis, the slopes of males with and without LVH did not differ to a statistically significant extent; however, the slope in female patients without LVH was significantly smaller than that of female patients with LVH. We then compared our data to the natural historical data that have previously been reported. In comparison to the previously reported data, we found a significant reduction in the LVM changes (g/height2.7/year) of patients who received long-term ERT (male, 4.07 ± 1.03 to 1.25 ± 1.39; female, 2.31 ± 0.81 to 0.78 ± 1.23). Long-term ERT effectively prevents LVH in Fabry patients. This effect was also observed in the patients with LVH prior to the initiation of ERT.
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Affiliation(s)
- Kenichi Hongo
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan.
| | - Keiichi Ito
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Taro Date
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Ikuko Anan
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Yasunori Inoue
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Satoshi Morimoto
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Kazuo Ogawa
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Makoto Kawai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Hiroshi Kobayashi
- Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Masahisa Kobayashi
- Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Hiroyuki Ida
- Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Toya Ohashi
- Department of Pediatrics, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Ikuo Taniguchi
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Yoshikatsu Eto
- Advanced Clinical Research Center, Institute of Neurological Disorders, Furusawa-Miyako 255, Asou-ku, Kawasaki city, Kanagawa Prefecture 215-0026, Japan
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Affiliation(s)
- Gere Sunder-Plassmann
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria
| | - Raphael Schiffmann
- Institute of Metabolic Disease, Baylor Research Institute, Dallas, TX, USA
| | - Kathleen Nicholls
- Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
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Abstract
Hereditary kidney disease comprises approximately 10% of adults and nearly all children who require renal replacement therapy. Technologic advances have improved our ability to perform genetic diagnosis and enhanced our understanding of renal and syndromic diseases. In this article, we review the genetics of renal diseases, including common monogenic diseases such as polycystic kidney disease, Alport syndrome, and Fabry disease, as well as complex disorders such as congenital anomalies of the kidney and urinary tract. We provide the nephrologist with a general strategy to approach hereditary disorders, which includes a discussion of commonly used genetic tests, a guide to genetic counseling, and reproductive options such as prenatal diagnosis or pre-implantation genetic diagnosis for at-risk couples. Finally, we review pregnancy outcomes in certain renal diseases.
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Affiliation(s)
- Lakshmi Mehta
- Division of Medical Genetics, Department of Genetics and Genomic Sciences/Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Belinda Jim
- Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, NY
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López Rodríguez M. Treatment in Fabry disease. Rev Clin Esp 2018; 218:489-495. [PMID: 29661503 DOI: 10.1016/j.rce.2018.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 03/19/2018] [Accepted: 03/20/2018] [Indexed: 01/19/2023]
Abstract
Fabry disease is an X-linked inborn disease caused by deficit of alpha-galactosidaseA. This results in accumulation of glycosphingolipids in all cells and tissues. All males should receive enzyme replacement treatment in case of very low or undetectable levels of alpha-galactosidaseA. Female carriers and males with marginally levels of alpha-galactosidaseA should be treated in case of renal, neurologic o cardiac manifestations. There are two intravenous formulations of human recombinant enzyme, agalsidase alpha and agalsidase beta, showing similar efficacy and safety. Patients with amenable mutations of alpha-galactosidase can be treated with oral migalastat hydrochloride. Migalastat hydrochloride is a pharmacological chaperone that facilitates trafficking of alpha-galactosidaseA to lysosomes increasing enzyme activity. Patients treated with migalastat hydrochloride had significant improvements in left ventricular mass and gastrointestinal symptoms.
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Affiliation(s)
- M López Rodríguez
- Grupo de Trabajo de Enfermedades Minoritarias, Sociedad Española de Medicina Interna (SEMI).
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Ortiz A, Germain DP, Desnick RJ, Politei J, Mauer M, Burlina A, Eng C, Hopkin RJ, Laney D, Linhart A, Waldek S, Wallace E, Weidemann F, Wilcox WR. Fabry disease revisited: Management and treatment recommendations for adult patients. Mol Genet Metab 2018. [PMID: 29530533 DOI: 10.1016/j.ymgme.2018.02.014] [Citation(s) in RCA: 344] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Fabry disease is an X-linked lysosomal storage disorder caused by mutations in the GLA gene leading to deficient α-galactosidase A activity, glycosphingolipid accumulation, and life-threatening complications. Phenotypes vary from the "classic" phenotype, with pediatric onset and multi-organ involvement, to later-onset, a predominantly cardiac phenotype. Manifestations are diverse in female patients in part due to variations in residual enzyme activity and X chromosome inactivation patterns. Enzyme replacement therapy (ERT) and adjunctive treatments can provide significant clinical benefit. However, much of the current literature reports outcomes after late initiation of ERT, once substantial organ damage has already occurred. Updated monitoring and treatment guidelines for pediatric patients with Fabry disease have recently been published. Expert physician panels were convened to develop updated, specific guidelines for adult patients. Management of adult patients depends on 1) a personalized approach to care, reflecting the natural history of the specific disease phenotype; 2) comprehensive evaluation of disease involvement prior to ERT initiation; 3) early ERT initiation; 4) thorough routine monitoring for evidence of organ involvement in non-classic asymptomatic patients and response to therapy in treated patients; 5) use of adjuvant treatments for specific disease manifestations; and 6) management by an experienced multidisciplinary team.
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Affiliation(s)
- Alberto Ortiz
- Unidad de Dialisis, IIS-Fundacion Jimenez Diaz, School of Medicine, UAM, IRSIN and REDINREN, Madrid, Spain.
| | - Dominique P Germain
- French Referral Center for Fabry disease, Division of Medical Genetics and INSERM U1179, University of Versailles, Paris-Saclay University, Montigny, France
| | - Robert J Desnick
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Juan Politei
- Department of Neurology, Fundacion Para el Estudio de Enfermedades Neurometabolicas (FESEN), Buenos Aires, Argentina
| | - Michael Mauer
- Departments of Pediatrics and Medicine, University of Minnesota, Minneapolis, MN, USA
| | | | - Christine Eng
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Robert J Hopkin
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Dawn Laney
- Division of Medical Genetics, Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Aleš Linhart
- 2nd Department of Internal - Cardiovascular Medicine, First Medical Faculty, Charles University, Prague, Czech Republic
| | - Stephen Waldek
- School of Pharmacy, University of Sunderland, Sunderland, UK
| | - Eric Wallace
- Department of Medicine, Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Frank Weidemann
- Department of Internal Medicine, Katharinen-Hospital Unna, Unna, Germany
| | - William R Wilcox
- Division of Medical Genetics, Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
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Macklin S, Laney D, Lisi E, Atherton A, Smith E. The Psychosocial Impact of Carrying a Debated Variant in the GLA Gene. J Genet Couns 2017; 27:217-224. [DOI: 10.1007/s10897-017-0139-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 07/26/2017] [Indexed: 12/20/2022]
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Luis SA, Maleszewski JJ, Young PM, Schaff HV, Pereira NL. Previously Unreported in Women
Galactosidase Alpha
Pro409Ser Variant Is Associated With Fabry Disease. ACTA ACUST UNITED AC 2017; 10:e001661. [DOI: 10.1161/circgenetics.116.001661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sushil Allen Luis
- From the Department of Cardiovascular Diseases (S.A.L., H.V.S., N.L.P.), Department of Laboratory Medicine and Pathology (J.J.M.), and Department of Radiology (P.M.Y.), Mayo Clinic, Rochester, MN
| | - Joseph J. Maleszewski
- From the Department of Cardiovascular Diseases (S.A.L., H.V.S., N.L.P.), Department of Laboratory Medicine and Pathology (J.J.M.), and Department of Radiology (P.M.Y.), Mayo Clinic, Rochester, MN
| | - Phillip M. Young
- From the Department of Cardiovascular Diseases (S.A.L., H.V.S., N.L.P.), Department of Laboratory Medicine and Pathology (J.J.M.), and Department of Radiology (P.M.Y.), Mayo Clinic, Rochester, MN
| | - Hartzell V. Schaff
- From the Department of Cardiovascular Diseases (S.A.L., H.V.S., N.L.P.), Department of Laboratory Medicine and Pathology (J.J.M.), and Department of Radiology (P.M.Y.), Mayo Clinic, Rochester, MN
| | - Naveen L. Pereira
- From the Department of Cardiovascular Diseases (S.A.L., H.V.S., N.L.P.), Department of Laboratory Medicine and Pathology (J.J.M.), and Department of Radiology (P.M.Y.), Mayo Clinic, Rochester, MN
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42
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Yogasundaram H, Kim D, Oudit O, Thompson RB, Weidemann F, Oudit GY. Clinical Features, Diagnosis, and Management of Patients With Anderson-Fabry Cardiomyopathy. Can J Cardiol 2017; 33:883-897. [DOI: 10.1016/j.cjca.2017.04.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 04/09/2017] [Accepted: 04/23/2017] [Indexed: 12/14/2022] Open
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Ali N, Gillespie S, Laney D. Treatment of Depression in Adults with Fabry Disease. JIMD Rep 2017; 38:13-21. [PMID: 28417336 PMCID: PMC5874216 DOI: 10.1007/8904_2017_21] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/08/2017] [Accepted: 03/10/2017] [Indexed: 12/12/2022] Open
Abstract
Fabry disease (FD) is a genetic X-linked, multisystemic, progressive lysosomal storage disorder (LSD). Depression has emerged as a disease complication, with prevalence estimates ranging from 15 to 62%. This is a pilot study examining the effects of psychological counseling for depression in FD on depression, adaptive functioning (AF), quality of life (QOL), and subjective pain experience. Telecounseling was also piloted, as it has beneficial effects in other chronic diseases which make in-person counseling problematic. Subjects completed 6 months of in-person or telecounseling with the same health psychologist, followed by 6 months without counseling. Self-report measures of depression, AF, QOL, and subjective pain were completed every 3 months. All subjects experienced improvements in depression, which were sustained during the follow-up period. Improvements in depression were correlated with improvements in mental health QOL and subjective pain severity, while improvements in mental health QOL were correlated with improvements in AF. While statistical comparison between counseling modes was not possible with the given sample size, relevant observations were noted. Recommendations for future research include replication of results with a larger sample size and a longer counseling period. The use of video counseling may be beneficial. In conclusion, the present pilot study supports the efficacy of psychological treatment for depression in people with FD, highlighting the importance of having health psychologists housed in LSD treatment centers, rather than specialty psychology/psychiatry settings, to increase participation and decrease potential obstacles to access due to perceived stigma.
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Affiliation(s)
- Nadia Ali
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Scott Gillespie
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Dawn Laney
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
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44
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Laney DA, Clarke V, Foley A, Hall EW, Gillespie SE, Holida M, Simmons M, Wadley A. The Impact of Fabry Disease on Reproductive Fitness. JIMD Rep 2017; 37:85-97. [PMID: 28324326 PMCID: PMC5740039 DOI: 10.1007/8904_2017_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 02/02/2017] [Accepted: 02/21/2017] [Indexed: 01/24/2023] Open
Abstract
Fabry disease (FD) is a pan-ethnic, X-linked, progressive lysosomal storage disorder caused by pathogenic mutations in the GLA gene. Published case reports and abstracts suggest that decreased reproductive fitness may occur in males with FD. In order to understand the impact of FD on reproductive fitness and increase the accuracy of reproductive genetic counseling, this study examines a large, multi-centered population of individuals with FD to determine if males have reduced reproductive fitness. Study data were collected on 376 patients through two, gender-specific surveys distributed across the United States and Canada. The number of biological live-born children among individuals with FD was compared to statistics from the general population. Information was also collected on reduced sperm count, depression, pain, use of assisted reproductive technology, and reproductive choice. On average, females affected by FD had more biological live-born children (1.8) than males affected by FD (1.1). However, males affected by FD had an increased mean number of biological children (1.1) compared to the mean number of biological children fathered by men in the United States (0.9). Sixteen of the 134 males with FD reported oligospermia, which suggests that an infertility work up may be indicated for males having difficulty impregnating their partners. In our large multicenter sample, males and females with FD do not exhibit reduced reproductive fitness; on average they have more biological children than the general population in the United States. This information should assist clinicians in providing accurate reproductive genetic counseling and treatment for individuals with FD.
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Affiliation(s)
- Dawn A. Laney
- Division of Medical Genetics, Department of Human Genetics, Emory University School of Medicine, 2165 North Decatur Road, Decatur, GA 30033 USA
| | - Virginia Clarke
- Neurology Department, Massachusetts General Hospital, Boston, MA USA
| | - Allison Foley
- Division of Medical Genetics, Department of Human Genetics, Emory University School of Medicine, 2165 North Decatur Road, Decatur, GA 30033 USA
| | - Eric W. Hall
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA USA
| | - Scott E. Gillespie
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA
| | - Myrl Holida
- Division of Medical Genetics, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA USA
| | - Morgan Simmons
- Division of Medical Genetics, Department of Human Genetics, Emory University School of Medicine, 2165 North Decatur Road, Decatur, GA 30033 USA
| | - Alexandrea Wadley
- University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
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45
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Azevedo O, Gago M, Miltenberger-Miltenyi G, Gaspar P, Sousa N, Cunha D. Mild Left Ventricular Hypertrophy Unravels a Novel Nonsense Mutation of the GLA Gene Associated with the Classical Phenotype of Fabry Disease. Cardiology 2017; 137:67-73. [DOI: 10.1159/000455117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 11/28/2016] [Indexed: 11/19/2022]
Abstract
We report on the clinical, biochemical, and genetic findings of a large family with the classical phenotype of Fabry disease due to the novel nonsense mutation c.607G>T (p.E203X) of the GLA gene, which occurs in the active site of the α-galactosidase A enzyme. This report highlights that (i) Fabry disease diagnosis should be considered in all cases of unexplained left ventricular hypertrophy (LVH), even in its milder forms; (ii) a complete evaluation of patients with unexplained LVH is important to find diagnostic red flags of treatable causes of LVH, such as Fabry disease; (iii) cascade family screening is paramount to the earlier diagnosis and treatment of other affected family members; and (iv) the Fabry disease phenotype is highly variable in heterozygote females, even within the same family.
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46
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Curiati MA, Aranda CS, Kyosen SO, Varela P, Pereira VG, D’Almeida V, Pesquero JB, Martins AM. The Challenge of Diagnosis and Indication for Treatment in Fabry Disease. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2017. [DOI: 10.1177/2326409816685735] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Marco A. Curiati
- Reference Center in Inborn Errors of Metabolism, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Carolina S. Aranda
- Reference Center in Inborn Errors of Metabolism, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sandra O. Kyosen
- Reference Center in Inborn Errors of Metabolism, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Patricia Varela
- Center for Research and Molecular Diagnosis of Genetic Diseases, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Vanessa G. Pereira
- Departament of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Vania D’Almeida
- Departament of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - João B. Pesquero
- Center for Research and Molecular Diagnosis of Genetic Diseases, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ana M. Martins
- Reference Center in Inborn Errors of Metabolism, Universidade Federal de São Paulo, São Paulo, Brazil
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47
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Firsov KV, Kotov AS. [The neurological manifestations of Fabry disease. A review]. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:98-105. [PMID: 27735906 DOI: 10.17116/jnevro20161169198-105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Fabry disease (Anderson-Fabry disease) is an X-linked recessive lysosomal storage disorder resulting from deficient activity of lysosomal hydrolase, alpha-galactosidase A (alpha-Gal A), which leads to progressive accumulation of globotriaosylceramide (Gb3) in various cells, predominantly endothelial and vascular smooth muscle cells, with clinical manifestations affecting major organs including the central nervous system. Manifestations of Fabry disease include progressive renal and cardiac insufficiency, neuropathic pain, stroke and cerebral disease, skin and gastrointestinal symptoms. Clinical onset usually occurs in childhood, but many severe patients are diagnosed in adulthood. Females may be severely affected as males and both may die prematurely due to stroke, heart disease and renal failure. Early recognition of symptoms, enzyme activity levels, concentration of Gb3 levels in the blood, urine and skin biopsies, as well as genetic testing (GLA gene) enable establishment of early diagnosis and therapeutic intervention with enzyme replacement therapy. Enzyme replacement therapy can stabilize or reduce the progression of the disease. Early therapy may prevent complications of the disease.
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Affiliation(s)
- K V Firsov
- Vladimirsky Moscow Regional Research Institute, Moscow, Russia
| | - A S Kotov
- Vladimirsky Moscow Regional Research Institute, Moscow, Russia
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48
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Beirão I, Cabrita A, Torres M, Silva F, Aguiar P, Gomes AM. Anderson-Fabry Disease. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2016. [DOI: 10.1177/2326409816669372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Idalina Beirão
- Centro Hospitalar do Porto, Largo Professor Abel Salazar, Porto, Portugal
| | - Ana Cabrita
- Service of Centro Hospitalar do Algarve, Rua Leao Penedo, Faro, Portugal
| | - Márcia Torres
- Centro Hospitalar do Médio Ave, Largo Domingos Moreira, Santo Tirso, Portugal
| | - Fernando Silva
- Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Patricio Aguiar
- Hospital de Santa Maria/Centro Hospitalar Lisboa Norte, Avenida Professor Egas Moniz, Lisboa, Portugal
| | - Ana Marta Gomes
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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49
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Multicenter Female Fabry Study (MFFS) - clinical survey on current treatment of females with Fabry disease. Orphanet J Rare Dis 2016; 11:88. [PMID: 27356758 PMCID: PMC4928260 DOI: 10.1186/s13023-016-0473-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/17/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The aim of the present study was to assess manifestations of and applied treatment concepts for females with Fabry disease (FD) according to the current European Fabry Guidelines. METHODS Between 10/2008 and 12/2014, data from the most recent visit of 261 adult female FD patients from six German Fabry centers were retrospectively analyzed. Clinical presentation and laboratory data, including plasma lyso-Gb3 levels were assessed. RESULTS Fifty-five percent of females were on enzyme replacement therapy (ERT), according to recent European FD guidelines. Thirty-three percent of females were untreated although criteria for ERT initiation were fulfilled. In general, the presence of left ventricular hypertrophy (LVH) seemed to impact more on ERT initiation than impaired renal function. In ERT-naïve females RAAS blockers were more often prescribed if LVH was present rather than albuminuria. Affected females with missense mutations showed a similar disease burden compared to females with nonsense mutations. Elevated plasma lyso-Gb3 levels in ERT-naïve females seem to be a marker of disease burden, since patients showed comparable incidences of organ manifestations even if they were ~8 years younger than females with normal lyso-Gb3 levels. CONCLUSION The treatment of the majority of females with FD in Germany is in line with the current European FD guidelines. However, a relevant number of females remain untreated despite organ involvement, necessitating a careful reevaluation of these females.
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Abstract
PURPOSE OF REVIEW Cerebrovascular disease (CeVD) remains a major cause of death and a leading cause of disability worldwide. CeVD is a complex and multifactorial disease caused by the interaction of vascular risk factors, environment, and genetic factors. In the present article, we discussed genetic susceptibility to CeVD, with particular emphasis on genetic studies of the associations between lipid traits and CeVD. RECENT FINDINGS Several animal and clinical studies clearly defined genetic predisposition to atherosclerosis and CeVD, and particularly to ischemic stroke. Recent evidence has shown that traditional vascular risk factors explain only a small proportion of variance in atherosclerosis, suggesting that additional nontraditional factors and novel genetic determinants impact CeVD. With the help of genome-wide technology, novel genetic variants have been implicated in CeVD and lipid metabolism such as those in protein convertase subtilisin/kexin type 9 (PCSK9) gene in stroke and familial hypercholesterolemia. These studies are important as they contribute to our understanding of the genetic mechanisms underlying CeVD and to developing more effective CeVD prevention strategies. SUMMARY CeVD is a complex and multifactorial disease and genetics likely plays an important role in its pathogenesis. The gene-gene and gene-environment interactions of genes involved in biology of vascular disease, including the lipid metabolism are important factors for individual susceptibility to CeVD. Accounting for individual variation in genes, environment and lifestyle will bring us closer to precision medicine, which is an emerging and recently introduced new approach for disease treatment and prevention in clinical practice.
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Affiliation(s)
- David Della-Morte
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Rome, Italy
- IRCCS San Raffaele Pisana, Rome, Italy
| | - Francesca Pacifici
- Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
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