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Palaiodimou L, Stefanou MI, Bakola E, Papadopoulou M, Kokotis P, Vrettou AR, Kapsia E, Petras D, Anastasakis A, Xifaras N, Karachaliou E, Touloumi G, Vlachopoulos C, Boletis IN, Giannopoulos S, Tsivgoulis G, Zompola C. D313Y Variant in Fabry Disease: A Systematic Review and Meta-analysis. Neurology 2022; 99:e2188-e2200. [PMID: 36344272 DOI: 10.1212/wnl.0000000000201102] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/27/2022] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is accumulating evidence in the literature indicating a strong correlation between Fabry disease (FD) phenotypes and specific sequence variations in the Galactosidase Alpha (GLA) gene. Among them, the potential pathogenicity and clinical relevance of D313Y variation in patients with FD remain debated. METHODS We performed a systematic review and meta-analysis of studies reporting D313Y as single occurring variant in the GLA gene and sought to evaluate (1) the prevalence of D313Y variation in different populations with or without clinical manifestations of FD, (2) the clinical FD phenotype in D313Y-positive patients, and (3) the proportion of D313Y-positive patients presenting abnormal laboratory findings (alpha-galactosidase-A deficiency or globotriaosylceramide accumulation). RESULTS Forty cohorts comprising 211 individuals with D313Y variation among 42,723 participants with available GLA gene-sequencing data were included. Patients highly suspected for FD had a higher prevalence of D313Y variation (4.9%, 95% CI 1.6%-9.9%; I2 = 95.5%) compared with the general population (0%, 95% CI 0%-0.1%; I2 = 1.9%; p = 0.004). The prevalence of D313Y variation was 0.6% (95% CI 0.3%-1%; I2 = 74.1%), 0.4% (95% CI 0.2%-0.7%; I2 = 0%), and 0.3% (95% CI 0.2%-0.4%; I2 = 0%) in patients presenting with neurologic, cardiac, or renal manifestations, respectively. D313Y was associated with a milder, late-onset FD phenotype, as indicated by the mean patient age of 51 years (95% CI 44-59; I2 = 94%) and the evidence of alpha-galactosidase A deficiency and globotriaosylceramide accumulation in 26.7% (95% CI 15.3%-40%; I2 = 34%) and 16.2% (95% CI 8%-26.4%; I2 = 35%) of cases, respectively. D313Y-positive patients displayed predominantly neurologic FD manifestations (58.1%, 95% CI 37.7%-77.1%; I2 = 78%), with central and peripheral nervous system (CNS/PNS) involvement noted in 28.2% (95% CI 15.4%-43.2%; I2 = 51%) and 28.5% (95% CI 17.8%-40.5%; I2 = 61%) of cases, respectively. DISCUSSION D313Y variation seems to correlate with an atypical, mild late-onset phenotype with predominantly neurologic FD manifestations. Monitoring for CNS/PNS involvement is thus paramount to identify D313Y-positive patients with latent or early-FD pathology, which may qualify for enzyme-replacement therapy or chaperone treatment.
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Affiliation(s)
- Lina Palaiodimou
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Maria-Ioanna Stefanou
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Eleni Bakola
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Marianna Papadopoulou
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Panagiotis Kokotis
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Agathi-Rosa Vrettou
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Eleni Kapsia
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Dimitrios Petras
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Aris Anastasakis
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Nikolaos Xifaras
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Eleni Karachaliou
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Giota Touloumi
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Charalambos Vlachopoulos
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Ioannis N Boletis
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Sotirios Giannopoulos
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Georgios Tsivgoulis
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN.
| | - Christina Zompola
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
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Tomek A, Petra R, Paulasová Schwabová J, Olšerová A, Škorňa M, Nevšímalová M, Šimůnek L, Herzig R, Fafejtová Š, Mikulenka P, Táboříková A, Neumann J, Brzezny R, Sobolová H, Bartoník J, Václavík D, Vachová M, Bechyně K, Havlíková H, Prax T, Šaňák D, Černíková I, Ondečková I, Procházka P, Rajner J, Škoda M, Novák J, Škoda O, Bar M, Mikulík R, Dostálová G, Linhart A. Nationwide screening for Fabry disease in unselected stroke patients. PLoS One 2021; 16:e0260601. [PMID: 34905550 PMCID: PMC8670679 DOI: 10.1371/journal.pone.0260601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 11/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background and aims Fabry disease (FD) is a rare X-linked lysosomal storage disorder caused by disease-associated variants in the alpha-galactosidase A gene (GLA). FD is a known cause of stroke in younger patients. There are limited data on prevalence of FD and stroke risk in unselected stroke patients. Methods A prospective nationwide study including 35 (78%) of all 45 stroke centers and all consecutive stroke patients admitted during three months. Clinical data were collected in the RES-Q database. FD was diagnosed using dried blood spots in a stepwise manner: in males—enzymatic activity, globotriaosylsphingosine (lyso-Gb3) quantification, if positive followed by GLA gene sequencing; and in females GLA sequencing followed by lyso-Gb3. Results 986 consecutive patients (54% men, mean age 70 years) were included. Observed stroke type was ischemic 79%, transient ischemic attack (TIA) 14%, intracerebral hemorrhage (ICH) 7%, subarachnoid hemorrhage 1% and cerebral venous thrombosis 0.1%. Two (0.2%, 95% CI 0.02–0.7) patients had a pathogenic variant associated with the classical FD phenotype (c.1235_1236delCT and p.G325S). Another fourteen (1.4%, 95% CI 0.08–2.4) patients had a variant of GLA gene considered benign (9 with p.D313Y, one p.A143T, one p.R118C, one p.V199A, one p.R30K and one p.R38G). The index stroke in two carriers of disease-associated variant was ischemic lacunar. In 14 carriers of GLA gene variants 11 strokes were ischemic, two TIA, and one ICH. Patients with positive as compared to negative GLA gene screening were younger (mean 60±SD, min, max, vs 70±SD, min, max, P = 0.02), otherwise there were no differences in other baseline variables. Conclusions The prevalence of FD in unselected adult patients with acute stroke is 0.2%. Both patients who had a pathogenic GLA gene variant were younger than 50 years. Our results support FD screening in patients that had a stroke event before 50 years of age.
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Affiliation(s)
- Aleš Tomek
- Second Faculty of Medicine, Department of Neurology, Charles University and University Hospital Motol, Prague, Czech Republic
- * E-mail:
| | - Reková Petra
- First Faculty of Medicine, Department of Neurology and Center of Clinical Neuroscience, Charles University and General University Hospital, Prague, Czech Republic
| | - Jaroslava Paulasová Schwabová
- Second Faculty of Medicine, Department of Neurology, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Anna Olšerová
- Second Faculty of Medicine, Department of Neurology, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Miroslav Škorňa
- Department of Neurology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Miroslava Nevšímalová
- Department of Neurology, Hospital České Budějovice, České Budějovice, Czech Republic
| | - Libor Šimůnek
- Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Department of Neurology, Hradec Králové, Czech Republic
| | - Roman Herzig
- Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Department of Neurology, Hradec Králové, Czech Republic
| | - Štěpánka Fafejtová
- Department of Neurology, Regional Hospital Karlovy Vary, Karlovy Vary, Czech Republic
| | - Petr Mikulenka
- 3 Medical Faculty, Department of Neurology Neurology Dpt., Charles University and University Hospital Kralovské Vinohrady, Prague, Czech Republic
| | - Alena Táboříková
- Department of Neurology Neurology Dpt., Krajská zdravotní, a.s.—Hospital Chomutov, Chomutov, Czech Republic
| | - Jiří Neumann
- Department of Neurology Neurology Dpt., Krajská zdravotní, a.s.—Hospital Chomutov, Chomutov, Czech Republic
| | - Richard Brzezny
- Department of Neurology Neurology Dpt., Regional Hospital Kladno, Kladno, Czech Republic
| | - Helena Sobolová
- Department of Neurology Neurology Dpt., Hospital Třinec, Třinec, Czech Republic
| | - Jan Bartoník
- Department of Neurology Neurology Dpt., Regional Hospital of Tomáš Baťa, Zlín, Czech Republic
| | - Daniel Václavík
- Department of Neurology, AGEL Research and Training Institute, Ostrava Vítkovice Hospital, Ostrava, Czech Republic
| | - Marta Vachová
- Department of Neurology, Krajská zdravotní, a.s.—Hospital Teplice, Teplice, Czech Republic
| | - Karel Bechyně
- Department of Neurology, Hospital Písek, Písek, Czech Republic
| | - Hana Havlíková
- Department of Neurology, Regional Hospital Liberec, Liberec, Czech Republic
| | - Tomáš Prax
- Department of Neurology, Regional Hospital Pardubice, Pardubice, Czech Republic
| | - Daniel Šaňák
- Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
| | - Irena Černíková
- Department of Neurology, Regional Hospital Kolín, Kolín, Czech Republic
| | - Iva Ondečková
- Department of Neurology, Krajská zdravotní, a.s.—Hospital Děčín, Děčín, Czech Republic
| | - Petr Procházka
- Department of Neurology, Regional Hospital Uherské Hradiště, Uherské Hradiště, Czech Republic
| | - Jan Rajner
- Department of Neurology, Municipal Hospital Ostrava, Ostrava, Czech Republic
| | - Miroslav Škoda
- Department of Neurology, Regional Hospital Náchod, Náchod, Czech Republic
| | - Jan Novák
- Department of Neurology, Regional Hospital Česká Lípa, Česká Lípa, Czech Republic
| | - Ondřej Škoda
- Department of Neurology, Hospital Jihlava, Jihlava, Czech Republic
| | - Michal Bar
- D epartment of Neurology, University Hospital Ostrava and Faculty of Medicine, Ostrava University, Ostrava, Czech Republic
| | - Robert Mikulík
- International Clinical Research Center and Department of Neurology, St. Anne’s University Hospital and Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Gabriela Dostálová
- First Faculty of Medicine, 2nd Department of Medicine–Department of Cardiovascular Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Aleš Linhart
- First Faculty of Medicine, 2nd Department of Medicine–Department of Cardiovascular Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Romani I, Nencini P, Sarti C, Pracucci G, Zedde M, Nucera A, Cianci V, Moller J, Toni D, Orsucci D, Casella C, Pinto V, Palumbo P, Barbarini L, Bella R, Ragno M, Scoditti U, Mezzapesa DM, Tassi R, Diomedi M, Cavallini A, Volpi G, Chiti A, Bigliardi G, Sacco S, Linoli G, Ricci S, Giordano A, Bonetti B, Rasura M, Cecconi E, Princiotta Cariddi L, Currò Dossi R, Melis M, Consoli D, Guidetti D, Biagini S, Accavone D, Inzitari D. Fabry-Stroke Italian Registry (FSIR): a nationwide, prospective, observational study about incidence and characteristics of Fabry-related stroke in young-adults. Presentation of the study protocol. Neurol Sci 2021; 43:2433-2439. [PMID: 34609660 PMCID: PMC8918192 DOI: 10.1007/s10072-021-05615-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
Background TIA and stroke, both ischemic and hemorrhagic, may complicate Fabry disease at young-adult age and be the first manifestation that comes to the clinician’s attention. No definite indications have yet been elaborated to guide neurologists in Fabry disease diagnostics. In current practice, it is usually sought in case of cryptogenic strokes (while Fabry-related strokes can also occur by classical pathogenic mechanisms) or through screening programs in young cerebrovascular populations. Data on recurrence and secondary prevention of Fabry’s stroke are scanty. Methods The study had a prospective observational design involving 33 Italian neurological Stroke Units. Considering the incidence of TIA/stroke in the European population aged < 60 years and the frequency of Fabry disease in this category (as foreseen by a pilot study held at the Careggi University-Hospital, Florence), we planned to screen for Fabry disease a total of 1740 < 60-year-old individuals hospitalized for TIA, ischemic, or hemorrhagic stroke. We investigated TIA and stroke pathogenesis through internationally validated scales and we gathered information on possible early signs of Fabry disease among all cerebrovascular patients. Every patient was tested for Fabry disease through dried blood spot analysis. Patients who received Fabry disease diagnosis underwent a 12-month follow-up to monitor stroke recurrence and multi-system progression after the cerebrovascular event. Discussion The potential implications of this study are as follows: (i) to add information about the yield of systematic screening for Fabry disease in a prospective large cohort of acute cerebrovascular patients; (ii) to deepen knowledge of clinical, pathophysiological, and prognostic characteristics of Fabry-related stroke.
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Affiliation(s)
- Ilaria Romani
- Department of Neurosciences, Psychology, Pharmacology, and Child Health (NEUROFARBA), University of Florence, Florence, Italy.
| | | | - Cristina Sarti
- Department of Neurosciences, Psychology, Pharmacology, and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Giovanni Pracucci
- Department of Neurosciences, Psychology, Pharmacology, and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | | | - Antonia Nucera
- Neurovascular Treatment Unit, Spaziani Hospital, Frosinone, Italy
| | - Vittoria Cianci
- Neurology, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | | | - Danilo Toni
- Emergency Department Stroke Unit, Umberto I Polyclinic Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Carmela Casella
- Stroke Unit, Department of Clinical and Experimental Medicine, AOU Policlinico G. Martino, University of Messina, Messina, Italy
| | - Vincenza Pinto
- Neurology and Stroke Unit, Di Summa - Perrino Hospital, Brindisi, Italy
| | - Pasquale Palumbo
- Neurology, Neurophysiopathology, and Stroke Unit, Santo Stefano Hospital, Prato, Italy
| | | | - Rita Bella
- Acute Cerebrovascular Diseases Unit, Vittorio Emanuele University Hospital, Catania, Italy
| | - Michele Ragno
- Division of Neurology, C. e G. Mazzoni Hospital and Madonna del Soccorso Hospital, Ascoli Piceno, Italy
| | - Umberto Scoditti
- Neurology - Stroke Care Program, Parma University Hospital, Parma, Italy
| | | | - Rossana Tassi
- Neurosonology and Stroke Unit, Siena University Hospital, Siena, Italy
| | - Marina Diomedi
- Neurovascular Treatment Unit, Tor Vergata Polyclinic Hospital, Rome, Italy
| | | | - Gino Volpi
- Neurology, San Iacopo Hospital, Pistoia, Italy
| | | | - Guido Bigliardi
- Stroke Unit, Sant'Agostino Estense New Hospital, Modena, Italy
| | - Simona Sacco
- Neurology and Stroke Unit, SS Filippo e Nicola Hospital , Avezzano, Italy
| | | | - Stefano Ricci
- Stroke Center - Neurology, Città Di Castello Hospital and Gubbio-Gualdo Tadino Hospital, Città di Castello, Italy
| | | | - Bruno Bonetti
- Stroke Unit, Verona University Hospital, Verona, Italy
| | | | | | | | | | - Marta Melis
- Neurology, Monserrato University Hospital, Cagliari, Italy
| | | | | | - Silvia Biagini
- Department of Neurosciences, Psychology, Pharmacology, and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Donatella Accavone
- Department of Neurosciences, Psychology, Pharmacology, and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Domenico Inzitari
- Department of Neurosciences, Psychology, Pharmacology, and Child Health (NEUROFARBA), University of Florence, Florence, Italy
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