1
|
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.
Collapse
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
| |
Collapse
|
2
|
Feillet F, Bonnemains C. [Phenylketonuria: new treatments]. Arch Pediatr 2013; 20:1165-8. [PMID: 23910161 DOI: 10.1016/j.arcped.2013.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 06/14/2013] [Accepted: 06/24/2013] [Indexed: 11/22/2022]
Abstract
Low phenylalanine diet has been the key treatment of phenylketonuria for more than 50years, allowing efficient management of thousands of PKU patients to date. However, non-compliance exists, mainly after adolescence. A medication for PKU received approval in Europe in 2009 (sapropterine dihydrochloride or Kuvan(®)) and can benefit to patients responsive to this drug. Other treatment options are available in some countries (glycomacropeptides, large neutral amino acids) or are currently under investigation (phenylalanine ammonia lyase, chaperones molecules, gene therapy).
Collapse
Affiliation(s)
- F Feillet
- Centre de référence des maladies héréditaires du métabolisme de Nancy, hôpital d'enfants, CHU de Brabois, 54500 Vandœuvre-les-Nancy, France.
| | | |
Collapse
|
3
|
Tang M, Odejinmi SI, Vankayalapati H, Wierenga K, Lai K. Innovative therapy for Classic Galactosemia - tale of two HTS. Mol Genet Metab 2012; 105:44-55. [PMID: 22018723 PMCID: PMC3253915 DOI: 10.1016/j.ymgme.2011.09.028] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 09/21/2011] [Accepted: 09/21/2011] [Indexed: 01/04/2023]
Abstract
Classic Galactosemia is an autosomal recessive disorder caused by the deficiency of galactose-1-phosphate uridylyltransferase (GALT), one of the key enzymes in the Leloir pathway of galactose metabolism. While the neonatal morbidity and mortality of the disease are now mostly prevented by newborn screening and galactose restriction, long-term outcome for older children and adults with this disorder remains unsatisfactory. The pathophysiology of Classic Galactosemia is complex, but there is convincing evidence that galactose-1-phosphate (gal-1P) accumulation is a major, if not the sole pathogenic factor. Galactokinase (GALK) inhibition will eliminate the accumulation of gal-1P from both dietary sources and endogenous production, and efforts toward identification of therapeutic small molecule GALK inhibitors are reviewed in detail. Experimental and computational high-throughput screenings of compound libraries to identify GALK inhibitors have been conducted, and subsequent studies aimed to characterize, prioritize, as well as to optimize the identified positives have been implemented to improve the potency of promising compounds. Although none of the identified GALK inhibitors inhibits glucokinase and hexokinase, some of them cross-inhibit other related enzymes in the GHMP small molecule kinase superfamily. While this finding may render the on-going hit-to-lead process more challenging, there is growing evidence that such cross-inhibition could also lead to advances in antimicrobial and anti-cancer therapies.
Collapse
Affiliation(s)
- M Tang
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - SI Odejinmi
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - H Vankayalapati
- Center for Investigational Therapeutics, Huntsman Cancer Institute, The University of Utah, Salt Lake City, Utah, U.S.A
| | - K Wierenga
- Department of Pediatrics, Section of Genetics, OUHSC, Oklahoma City, Oklahoma, U.S.A
- Corresponding Authors: Kent Lai, Ph.D., Department of Pediatrics, Division of Medical Genetics, University of Utah School of Medicine, 50 N. Mario Capecchi Drive, SOM Room 2C412, Salt Lake City, UT 84132, U.S.A., (); KlaasWierenga, M.D., Department of Pediatrics, Section of Genetics, OUHSC, OUCP Suite 12100, Oklahoma City, OK 73104, U.S.A., ()
| | - K Lai
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
- Corresponding Authors: Kent Lai, Ph.D., Department of Pediatrics, Division of Medical Genetics, University of Utah School of Medicine, 50 N. Mario Capecchi Drive, SOM Room 2C412, Salt Lake City, UT 84132, U.S.A., (); KlaasWierenga, M.D., Department of Pediatrics, Section of Genetics, OUHSC, OUCP Suite 12100, Oklahoma City, OK 73104, U.S.A., ()
| |
Collapse
|
4
|
Current world literature. Curr Opin Pediatr 2011; 23:700-7. [PMID: 22068136 DOI: 10.1097/mop.0b013e32834dda34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|