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Nowak A, Botha J, Anagnostopoulou C, Hughes DA. Clinical outcomes in elderly patients receiving agalsidase alfa treatment in the Fabry Outcome Survey. Mol Genet Metab 2024; 143:108561. [PMID: 39159540 DOI: 10.1016/j.ymgme.2024.108561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 07/31/2024] [Accepted: 07/31/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND AND OBJECTIVES Treatment with agalsidase alfa in patients with Fabry disease is most effective when initiated early in the disease course; however, the clinical benefits in elderly patients are less well established. This analysis assesses outcomes in patients aged 65 years or older from the Fabry Outcome Survey (FOS) who were treated with agalsidase alfa. METHODS FOS data were extracted for adult patients aged 65 years or older who received agalsidase alfa, had baseline data and at least 3 years of post-baseline data, and had undergone no renal transplantation and/or dialysis before treatment. The data of patients who had undergone renal transplantation and/or dialysis during follow-up were excluded from estimated glomerular filtration rate (eGFR) analysis after the date of the renal transplantation and/or dialysis. Adult patients were stratified into two groups: those who started treatment before 65 years of age and who were still being treated when aged 65 years or older (group A), and those who started treatment when aged 65 years or older (group B). Mean annual changes in left ventricular mass index (LVMI), eGFR and proteinuria were assessed in group A (before and after the age of 65 years to understand if there was an age-related effect once patients turned 65 years of age) and in group B. RESULTS Estimated mean (standard error [SE]) annual changes in LVMI were 0.46 (0.26) g/m2.7 and 0.21 (0.42) g/m2.7 in patients in group A when they were younger than 65 years and when they were aged 65 years or older, respectively, and 0.12 (0.65) g/m2.7 in patients in group B. For eGFR, mean (SE) annual changes were 0.83 (2.12) mL/min/1.73 m2 and 2.64 (2.18) mL/min/1.73 m2 in patients in group A when they were younger than 65 years and when they were aged 65 years or older, respectively, and 2.31 (1.44) mL/min/1.73 m2 in patients in group B. Proteinuria remained relatively stable in both subgroups of group A (before and after the age of 65 years) and group B. CONCLUSIONS Continuation and initiation of agalsidase alfa treatment in patients aged 65 years or older with Fabry disease were associated with stabilization of proteinuria and minimal increases in cardiac (LVMI) and renal (eGFR) outcomes.
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Affiliation(s)
- Albina Nowak
- Department of Endocrinology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland; Department of Internal Medicine, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland.
| | - Jaco Botha
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | | | - Derralynn A Hughes
- Lysosomal Storage Disorders Unit, Royal Free London NHS Foundation Trust, University College London, London, UK
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Schindehütte M, Weiner S, Klug K, Hölzli L, Nauroth-Kreß C, Hessenauer F, Kampf T, Homola GA, Nordbeck P, Wanner C, Sommer C, Üçeyler N, Pham M. Dorsal root ganglion magnetic resonance imaging biomarker correlations with pain in Fabry disease. Brain Commun 2024; 6:fcae155. [PMID: 38751382 PMCID: PMC11095551 DOI: 10.1093/braincomms/fcae155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/20/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024] Open
Abstract
Fabry disease is a rare monogenetic, X-linked lysosomal storage disorder with neuropathic pain as one characteristic symptom. Impairment of the enzyme alpha-galactosidase A leads to an accumulation of globotriaosylceramide in the dorsal root ganglia. Here, we investigate novel dorsal root ganglia MR imaging biomarkers and their association with Fabry genotype and pain phenotype. In this prospective study, 89 Fabry patients were examined using a standardized 3 T MRI protocol of the dorsal root ganglia. Fabry pain was assessed through a validated Fabry pain questionnaire. The genotype was determined by diagnostic sequencing of the alpha-galactosidase A gene. MR imaging end-points were dorsal root ganglia volume by voxel-wise morphometric analysis and dorsal root ganglia T2 signal. Reference groups included 55 healthy subjects and Fabry patients of different genotype categories without Fabry pain. In patients with Fabry pain, T2 signal of the dorsal root ganglia was increased by +39.2% compared to healthy controls (P = 0.001) and by +29.4% compared to painless Fabry disease (P = 0.017). This effect was pronounced in hemizygous males (+40.7% compared to healthy; P = 0.008 and +29.1% compared to painless; P = 0.032) and was consistently observed across the genotype spectrum of nonsense (+38.1% compared to healthy, P < 0.001) and missense mutations (+39.2% compared to healthy; P = 0.009). T2 signal of dorsal root ganglia and globotriaosylsphingosine levels were the only independent predictors of Fabry pain (P = 0.047; P = 0.002). Volume of dorsal root ganglia was enlarged by +46.0% in Fabry males in the nonsense compared to missense genotype category (P = 0.005) and by +34.5% compared to healthy controls (P = 0.034). In painful Fabry disease, MRI T2 signal of dorsal root ganglia is increased across different genotypes. Dorsal root ganglion MRI T2 signal as a novel in vivo imaging biomarker may help to better understand whether Fabry pain is modulated or even caused by dorsal root ganglion pathology.
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Affiliation(s)
- Magnus Schindehütte
- Department of Neuroradiology, University Hospital Würzburg, Würzburg 97080, Germany
| | - Simon Weiner
- Department of Neuroradiology, University Hospital Würzburg, Würzburg 97080, Germany
| | - Katharina Klug
- Department of Neurology, University Hospital Würzburg, Würzburg 97080, Germany
| | - Lea Hölzli
- Department of Neuroradiology, University Hospital Würzburg, Würzburg 97080, Germany
| | | | - Florian Hessenauer
- Department of Neuroradiology, University Hospital Würzburg, Würzburg 97080, Germany
| | - Thomas Kampf
- Department of Neuroradiology, University Hospital Würzburg, Würzburg 97080, Germany
| | - György A Homola
- Department of Neuroradiology, University Hospital Würzburg, Würzburg 97080, Germany
| | - Peter Nordbeck
- Department of Internal Medicine, University Hospital Würzburg, Würzburg 97080, Germany
| | - Christoph Wanner
- Department of Internal Medicine, University Hospital Würzburg, Würzburg 97080, Germany
| | - Claudia Sommer
- Department of Neurology, University Hospital Würzburg, Würzburg 97080, Germany
| | - Nurcan Üçeyler
- Department of Neurology, University Hospital Würzburg, Würzburg 97080, Germany
| | - Mirko Pham
- Department of Neuroradiology, University Hospital Würzburg, Würzburg 97080, Germany
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Cordeiro RA, Rosa Neto NS, Giardini HAM. What should rheumatologists know about Gaucher disease and Fabry disease? Connecting the dots for an overview. Adv Rheumatol 2024; 64:22. [PMID: 38520029 DOI: 10.1186/s42358-024-00362-2] [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: 01/12/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024] Open
Abstract
Gaucher and Fabry diseases are lysosomal storage disorders in which deficient enzyme activity leads to pathological accumulation of sphingolipids. These diseases have a broad phenotypic presentation. Musculoskeletal symptoms and pain complaints are frequently reported by patients. Thus, rheumatologists can be contacted by these patients, contributing to the correct diagnosis, earlier indication of appropriate treatment and improvement of their prognosis. This review describes important concepts about Gaucher and Fabry diseases that rheumatologists should understand to improve patients' quality of life and change the natural history of these diseases.
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Affiliation(s)
- Rafael Alves Cordeiro
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, 455, 3 andar, sala 3184, Cerqueira Cesar, Sao Paulo, SP, CEP 01246-903, Brazil.
| | - Nilton Salles Rosa Neto
- Centro de Doenças Raras e da Imunidade, Hospital Nove de Julho, São Paulo, Brazil
- Universidade Santo Amaro, São Paulo, Brazil
| | - Henrique Ayres Mayrink Giardini
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, 455, 3 andar, sala 3184, Cerqueira Cesar, Sao Paulo, SP, CEP 01246-903, Brazil
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Tuttolomondo A, Baglio I, Riolo R, Todaro F, Parrinello G, Miceli S, Simonetta I. Molecular Pathogenesis of Central and Peripheral Nervous System Complications in Anderson-Fabry Disease. Int J Mol Sci 2023; 25:61. [PMID: 38203231 PMCID: PMC10779326 DOI: 10.3390/ijms25010061] [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: 12/02/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 01/12/2024] Open
Abstract
Fabry disease (FD) is a recessive monogenic disease linked to chromosome X due to more than two hundred mutations in the alfa-galactosidase A (GLA) gene. Modifications of the GLA gene may cause the progressive accumulation of globotriaosylceramide (Gb3) and its deacylated form, globotriasylsphingosine (lyso-Gb3), in lysosomes of several types of cells of the heart, kidneys, skin, eyes, peripheral and central nervous system (not clearly and fully demonstrated), and gut with different and pleiotropic clinical symptoms. Among the main symptoms are acroparesthesias and pain crisis (involving the peripheral nervous system), hypohidrosis, abdominal pain, gut motility abnormalities (involving the autonomic system), and finally, cerebrovascular ischemic events due to macrovascular involvement (TIA and stroke) and lacunar strokes and white matter abnormalities due to a small vessel disease (SVS). Gb3 lysosomal accumulation causes cytoplasmatic disruption and subsequent cell death. Additional consequences of Gb3 deposits are inflammatory processes, abnormalities of leukocyte function, and impaired trafficking of some types of immune cells, including lymphocytes, monocytes, CD8+ cells, B cells, and dendritic cells. The involvement of inflammation in AFD pathogenesis conflicts with the reported poor correlation between CRP levels as an inflammation marker and clinical scores such as the Mainz Severity Score Index (MSSI). Also, some authors have suggested an autoimmune reaction is involved in the disease's pathogenetic mechanism after the α-galactosidase A deficiency. Some studies have reported a high degree of neuronal apoptosis inhibiting protein as a critical anti-apoptotic mediator in children with Fabry disease compared to healthy controls. Notably, this apoptotic upregulation did not change after treatment with enzymatic replacement therapy (ERT), with a further upregulation of the apoptosis-inducing factor after ERT started. Gb3-accumulation has been reported to increase the degree of oxidative stress indexes and the production of reactive oxygen species (ROS). Lipids and proteins have been reported as oxidized and not functioning. Thus, neurological complications are linked to different pathogenetic molecular mechanisms. Progressive accumulation of Gb3 represents a possible pathogenetic event of peripheral nerve involvement. In contrast, central nervous system participation in the clinical setting of cerebrovascular ischemic events seems to be due to the epitheliopathy of Anderson-Fabry disease with lacunar lesions and white matter hyperintensities (WMHs). In this review manuscript, we revised molecular mechanisms of peripheral and central neurological complications of Anderson-Fabry Disease. The management of Fabry disease may be improved by the identification of biomarkers that reflect the clinical course, severity, and progression of the disease. Intensive research on biomarkers has been conducted over the years to detect novel markers that may potentially be used in clinical practice as a screening tool, in the context of the diagnostic process and as an indicator of response to treatment. Recent proteomic or metabolomic studies are in progress, investigating plasma proteome profiles in Fabry patients: these assessments may be useful to characterize the molecular pathology of the disease, improve the diagnostic process, and monitor the response to treatment.
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Affiliation(s)
- Antonino Tuttolomondo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, “G. D’Alessandro”, University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (I.B.); (R.R.); (F.T.); (G.P.); (S.M.); (I.S.)
- Fabry Disease Regional Reference Centre, Internal Medicine and Stroke Care Ward, University Hospital Policlinico “P. Giaccone”, 90127 Palermo, Italy
| | - Irene Baglio
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, “G. D’Alessandro”, University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (I.B.); (R.R.); (F.T.); (G.P.); (S.M.); (I.S.)
- Fabry Disease Regional Reference Centre, Internal Medicine and Stroke Care Ward, University Hospital Policlinico “P. Giaccone”, 90127 Palermo, Italy
| | - Renata Riolo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, “G. D’Alessandro”, University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (I.B.); (R.R.); (F.T.); (G.P.); (S.M.); (I.S.)
- Fabry Disease Regional Reference Centre, Internal Medicine and Stroke Care Ward, University Hospital Policlinico “P. Giaccone”, 90127 Palermo, Italy
| | - Federica Todaro
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, “G. D’Alessandro”, University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (I.B.); (R.R.); (F.T.); (G.P.); (S.M.); (I.S.)
- Fabry Disease Regional Reference Centre, Internal Medicine and Stroke Care Ward, University Hospital Policlinico “P. Giaccone”, 90127 Palermo, Italy
| | - Gaspare Parrinello
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, “G. D’Alessandro”, University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (I.B.); (R.R.); (F.T.); (G.P.); (S.M.); (I.S.)
| | - Salvatore Miceli
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, “G. D’Alessandro”, University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (I.B.); (R.R.); (F.T.); (G.P.); (S.M.); (I.S.)
- Fabry Disease Regional Reference Centre, Internal Medicine and Stroke Care Ward, University Hospital Policlinico “P. Giaccone”, 90127 Palermo, Italy
| | - Irene Simonetta
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, “G. D’Alessandro”, University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (I.B.); (R.R.); (F.T.); (G.P.); (S.M.); (I.S.)
- Fabry Disease Regional Reference Centre, Internal Medicine and Stroke Care Ward, University Hospital Policlinico “P. Giaccone”, 90127 Palermo, Italy
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Alkhatib D, Vega JA, Pour-Ghaz I, Al-Taweel O, Khan S, DeCarr K, Bath A, Rawal A, Wilbanks D, Raja J, Butt A, Yedlapati N, Hopkin RJ, Jefferies JL. Prevalence of lymphedema among Anderson-Fabry disease patients: A report from the Fabry registry. Mol Genet Metab 2023; 138:107538. [PMID: 36812723 DOI: 10.1016/j.ymgme.2023.107538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Anderson-Fabry disease (AFD) is a rare X-linked lysosomal storage disease due to a genetic variation in the α-galactosidase A (GLA) gene. As a result, the activity of the α-galactosidase A (AGAL-A) enzyme is reduced or absent, which causes sphingolipid deposition within different body parts. AFD typically manifests with cardiovascular, renal, cerebrovascular, and dermatologic involvement. Lymphedema is caused by sphingolipid deposition within lymphatics. Lymphedema can cause intolerable pain and limit daily activities. Very limited data exist on lymphedema in AFD patients. METHODS Using data from the Fabry Registry (NCT00196742) with 7671 patients included (44% males and 56% females), we analyzed the prevalence of lymphedema among AFD patients who were ever assessed for lymphedema and studied the age of first reported lymphedema. Additionally, we assessed whether patients received AFD-specific treatment at some point during their clinical course. The data was stratified by gender and phenotype. RESULTS Our study showed that lymphedema occurred in 16.5% of the Fabry Registry patients who were ever assessed for lymphedema (n = 5487). Male patients when compared to female patient have higher prevalence (21.7% vs 12.7%) and experienced lymphedema at a younger age (median age at first reported lymphedema of 43.7 vs 51.7 years). When compared to other phenotypes, classic phenotype has the highest prevalence of lymphedema with the earliest reported lymphedema. Among those who reported lymphedema, 84.5% received AFD-specific treatment during their clinical course. CONCLUSIONS Lymphedema is a common manifestation of AFD in both genders, with a tendency to present later in female patients. Recognition of lymphedema can offer an important opportunity for intervention and potential impact on associated morbidity. Additional future studies are needed to characterize the clinical implications of lymphedema in AFD patients and identify additional treatment options for this growing population.
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Affiliation(s)
- Deya Alkhatib
- Division of Cardiovascular Disease, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
| | - Jesus Avila Vega
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Issa Pour-Ghaz
- Division of Cardiovascular Disease, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Omar Al-Taweel
- Cardiology, Las Vegas School of Medicine, University of Nevada, Las Vegas, NV 89154, USA
| | - Sania Khan
- Division of Cardiovascular Disease, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Kimberly DeCarr
- The University of Tennessee Health Science Center - College of Medicine, Memphis, TN 38163, USA
| | - Anandbir Bath
- Division of Cardiovascular Disease, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Aranyak Rawal
- Division of Cardiovascular Disease, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - David Wilbanks
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Joel Raja
- Division of Cardiovascular Disease, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Asra Butt
- Division of Cardiovascular Disease, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Neeraja Yedlapati
- Division of Cardiovascular Disease, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Robert J Hopkin
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - John L Jefferies
- Division of Cardiovascular Disease, University of Tennessee Health Science Center, Memphis, TN 38163, USA
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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, 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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Liu Y, Yeung WSB, Chiu PCN, Cao D. Computational approaches for predicting variant impact: An overview from resources, principles to applications. Front Genet 2022; 13:981005. [PMID: 36246661 PMCID: PMC9559863 DOI: 10.3389/fgene.2022.981005] [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: 06/29/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
One objective of human genetics is to unveil the variants that contribute to human diseases. With the rapid development and wide use of next-generation sequencing (NGS), massive genomic sequence data have been created, making personal genetic information available. Conventional experimental evidence is critical in establishing the relationship between sequence variants and phenotype but with low efficiency. Due to the lack of comprehensive databases and resources which present clinical and experimental evidence on genotype-phenotype relationship, as well as accumulating variants found from NGS, different computational tools that can predict the impact of the variants on phenotype have been greatly developed to bridge the gap. In this review, we present a brief introduction and discussion about the computational approaches for variant impact prediction. Following an innovative manner, we mainly focus on approaches for non-synonymous variants (nsSNVs) impact prediction and categorize them into six classes. Their underlying rationale and constraints, together with the concerns and remedies raised from comparative studies are discussed. We also present how the predictive approaches employed in different research. Although diverse constraints exist, the computational predictive approaches are indispensable in exploring genotype-phenotype relationship.
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Affiliation(s)
- Ye Liu
- Shenzhen Key Laboratory of Fertility Regulation, Reproductive Medicine Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - William S. B. Yeung
- Shenzhen Key Laboratory of Fertility Regulation, Reproductive Medicine Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Obstetrics and Gynaecology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Philip C. N. Chiu
- Shenzhen Key Laboratory of Fertility Regulation, Reproductive Medicine Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Obstetrics and Gynaecology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Dandan Cao
- Shenzhen Key Laboratory of Fertility Regulation, Reproductive Medicine Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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Cybulla M, Nicholls K, Feriozzi S, Linhart A, Torras J, Vujkovac B, Botha J, Anagnostopoulou C, West ML. Renoprotective Effect of Agalsidase Alfa: A Long-Term Follow-Up of Patients with Fabry Disease. J Clin Med 2022; 11:jcm11164810. [PMID: 36013057 PMCID: PMC9410255 DOI: 10.3390/jcm11164810] [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: 06/30/2022] [Revised: 08/11/2022] [Accepted: 08/13/2022] [Indexed: 12/04/2022] Open
Abstract
Fabry disease is a rare lysosomal storage disorder caused by mutations in the GLA gene, which, without treatment, can cause significant renal dysfunction. We evaluated the effects of enzyme replacement therapy with agalsidase alfa on renal decline in patients with Fabry disease using data from the Fabry Outcome Survey (FOS) registry. Male patients with Fabry disease aged >16 years at agalsidase alfa start were stratified by low (≤0.5 g/24 h) or high (>0.5 g/24 h) baseline proteinuria and by ‘classic’ or ‘non-classic’ phenotype. Overall, 193 male patients with low (n = 135) or high (n = 58) baseline proteinuria were evaluated. Compared with patients with low baseline proteinuria, those with high baseline proteinuria had a lower mean ± standard deviation baseline eGFR (89.1 ± 26.2 vs. 106.6 ± 21.8 mL/min/1.73 m2) and faster mean ± standard error eGFR decline (−3.62 ± 0.42 vs. −1.61 ± 0.28 mL/min/1.73 m2 per year; p < 0.0001). Patients with classic Fabry disease had similar rates of eGFR decline irrespective of baseline proteinuria; only one patient with non-classic Fabry disease had high baseline proteinuria, preventing meaningful comparisons between groups. In this analysis, baseline proteinuria significantly impacted the rate of eGFR decline in the overall population, suggesting that early treatment with good proteinuria control may be associated with renoprotective effects.
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Affiliation(s)
- Markus Cybulla
- Center of Internal Medicine, Department of Nephrology and Rheumatology, Nephrologicum Markgräflerland MVZ, 79379 Müllheim, Germany
- Correspondence:
| | - Kathleen Nicholls
- Department of Nephrology, Royal Melbourne Hospital, Parkville, VIC 3050, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
| | - Sandro Feriozzi
- Nephrology and Dialysis Unit, Belcolle Hospital, 01100 Viterbo, Italy
| | - Aleš Linhart
- Second Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, 12808 Prague, Czech Republic
| | - Joan Torras
- Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Faculty of Medicine, Campus Bellvitge, University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Bojan Vujkovac
- Department of Internal Medicine, Slovenj Gradec General Hospital, 2380 Slovenj Gradec, Slovenia
| | - Jaco Botha
- Takeda Pharmaceuticals International AG, 8152 Zurich, Switzerland
| | | | - Michael L. West
- Department of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
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10
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X-chromosome inactivation patterns in females with Fabry disease examined by both ultra-deep RNA sequencing and methylation-dependent assay. Clin Exp Nephrol 2021; 25:1224-1230. [PMID: 34128148 DOI: 10.1007/s10157-021-02099-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 06/09/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Fabry disease is an X-linked inherited lysosomal storage disorder caused by mutations in the gene encoding α-galactosidase A. Males are usually severely affected, while females have a wide range of disease severity. This variability has been assumed to be derived from organ-dependent skewed X-chromosome inactivation (XCI) patterns in each female patient. Previous studies examined this correlation using the classical methylation-dependent method; however, conflicting results were obtained. This study was established to ascertain the existence of skewed XCI in nine females with heterozygous pathogenic variants in the GLA gene and its relationship to the phenotypes. METHODS We present five female patients from one family and four individual female patients with Fabry disease. In all cases, heterozygous pathogenic variants in the GLA gene were detected. The X-chromosome inactivation patterns in peripheral blood leukocytes and cells of urine sediment were determined by both classical methylation-dependent HUMARA assay and ultra-deep RNA sequencing. Fabry Stabilization Index was used to determine the clinical severity. RESULTS Skewed XCI resulting in predominant inactivation of the normal allele was observed only in one individual case with low ⍺-galactosidase A activity. In the remaining cases, no skewing was observed, even in the case with the highest total severity score (99.2%). CONCLUSION We conclude that skewed XCI could not explain the severity of female Fabry disease and is not the main factor in the onset of various clinical symptoms in females with Fabry disease.
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Sachau J, Kersebaum D, Baron R, Dickenson AH. Unusual Pain Disorders - What Can Be Learned from Them? J Pain Res 2021; 13:3539-3554. [PMID: 33758536 PMCID: PMC7980038 DOI: 10.2147/jpr.s287603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/18/2021] [Indexed: 12/13/2022] Open
Abstract
Pain is common in many different disorders and leads to a significant reduction in quality of life in the affected patients. Current treatment options are limited and often result in insufficient pain relief, partly due to the incomplete understanding of the underlying pathophysiological mechanisms. The identification of these pathomechanisms is therefore a central object of current research. There are also a number of rare pain diseases, that are generally little known and often undiagnosed, but whose correct diagnosis and examination can help to improve the management of pain disorders in general. In some of these unusual pain disorders like sodium-channelopathies or sensory modulation disorder the underlying pathophysiological mechanisms have only recently been unravelled. These mechanisms might serve as pharmacological targets that may also play a role in subgroups of other, more common pain diseases. In other unusual pain disorders, the identification of pathomechanisms has already led to the development of new drugs. A completely new therapeutic approach, the gene silencing, can even stop progression in hereditary transthyretin amyloidosis and porphyria, ie in pain diseases that would otherwise be rapidly fatal if left untreated. Thus, pain therapists and researchers should be aware of these rare and unusual pain disorders as they offer the unique opportunity to study mechanisms, identify new druggable targets and finally because early diagnosis might save many patient lives.
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Affiliation(s)
- Juliane Sachau
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, 24105, Germany
| | - Dilara Kersebaum
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, 24105, Germany
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, 24105, Germany
| | - Anthony H Dickenson
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, WC1E 6BT, UK
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Weissmann C, Albanese AA, Contreras NE, Gobetto MN, Castellanos LCS, Uchitel OD. Ion channels and pain in Fabry disease. Mol Pain 2021; 17:17448069211033172. [PMID: 34284652 PMCID: PMC8299890 DOI: 10.1177/17448069211033172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 12/29/2022] Open
Abstract
Fabry disease (FD) is a progressive, X-linked inherited disorder of glycosphingolipid metabolism due to deficient or absent lysosomal α-galactosidase A (α-Gal A) activity which results in progressive accumulation of globotriaosylceramide (Gb3) and related metabolites. One prominent feature of Fabry disease is neuropathic pain. Accumulation of Gb3 has been documented in dorsal root ganglia (DRG) as well as other neurons, and has lately been associated with the mechanism of pain though the pathophysiology is still unclear. Small fiber (SF) neuropathy in FD differs from other entities in several aspects related to the perception of pain, alteration of fibers as well as drug therapies used in the practice with patients, with therapies far from satisfying. In order to develop better treatments, more information on the underlying mechanisms of pain is needed. Research in neuropathy has gained momentum from the development of preclinical models where different aspects of pain can be modelled and further analyzed. This review aims at describing the different in vitro and FD animal models that have been used so far, as well as some of the insights gained from their use. We focus especially in recent findings associated with ion channel alterations -that apart from the vascular alterations-, could provide targets for improved therapies in pain.
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Affiliation(s)
- Carina Weissmann
- Instituto de Fisiología, Biología Molecular y Neurociencias (IFIBYNE-UBA-CONICET) and Departamento de Fisiología, Biología Molecular y Celular, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad Universitaria, Buenos Aires C1428EHA, Argentina
| | - Adriana A Albanese
- Instituto de Fisiología, Biología Molecular y Neurociencias (IFIBYNE-UBA-CONICET) and Departamento de Fisiología, Biología Molecular y Celular, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad Universitaria, Buenos Aires C1428EHA, Argentina
| | - Natalia E Contreras
- Instituto de Fisiología, Biología Molecular y Neurociencias (IFIBYNE-UBA-CONICET) and Departamento de Fisiología, Biología Molecular y Celular, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad Universitaria, Buenos Aires C1428EHA, Argentina
| | - María N Gobetto
- Instituto de Fisiología, Biología Molecular y Neurociencias (IFIBYNE-UBA-CONICET) and Departamento de Fisiología, Biología Molecular y Celular, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad Universitaria, Buenos Aires C1428EHA, Argentina
| | - Libia C Salinas Castellanos
- Instituto de Fisiología, Biología Molecular y Neurociencias (IFIBYNE-UBA-CONICET) and Departamento de Fisiología, Biología Molecular y Celular, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad Universitaria, Buenos Aires C1428EHA, Argentina
| | - Osvaldo D Uchitel
- Instituto de Fisiología, Biología Molecular y Neurociencias (IFIBYNE-UBA-CONICET) and Departamento de Fisiología, Biología Molecular y Celular, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad Universitaria, Buenos Aires C1428EHA, Argentina
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Al-Obaide MAI, Al-Obaidi II, Vasylyeva TL. Unexplored regulatory sequences of divergently paired GLA and HNRNPH2 loci pertinent to Fabry disease in human kidney and skin cells: Presence of an active bidirectional promoter. Exp Ther Med 2020; 21:154. [PMID: 33456521 PMCID: PMC7792484 DOI: 10.3892/etm.2020.9586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/01/2020] [Indexed: 12/21/2022] Open
Abstract
Fabry disease (FD) is a rare hereditary disorder characterized by a wide range of symptoms caused by a variety of mutations in the galactosidase α (GLA) gene. The heterogeneous nuclear ribonucleoprotein (HNRNPH2) gene is divergently paired with GLA on chromosome X and is thought to be implicated in FD. However, insufficient information is available on the regulatory mechanisms associated with the expression of HNRNPH2 and the GLA loci. Therefore, the current study performed bioinformatics analyses to assess the GLA and HNRNPH2 loci and investigate the regulatory mechanisms involved in the expression of each gene. The regulatory mechanisms underlying GLA and HNRNPH2 were revealed. The expression of each gene was associated with a bidirectional promoter (BDP) characterized by the absence of TATA box motifs and the presence of specific transcription factor binding sites (TFBSs) and a CpG Island (CGI). The nuclear run-on transcription assay confirmed the activity of BDP GLA and HNRNPH2 transcription in 293T. Methylation-specific PCR analysis demonstrated a statistically significant variation in the DNA methylation pattern of BDP in several cell lines, including human adult epidermal keratinocytes (AEKs), human renal glomerular endothelial cells, human renal epithelial cells and 293T cells. The highest observed significance was demonstrated in AEKs (P<0.05). The results of the chromatin-immunoprecipitation assay using 293T cells identified specific TFBS motifs for Yin Yang 1 and nuclear respiratory factor 1 transcription factors in BDPs. The National Center for Biotechnology Information-single nucleotide polymorphism database revealed pathogenic variants in the BDP sequence. Additionally, a previously reported variant associated with a severe heterozygous female case of GLA FD was mapped in BDP. The results of the present study suggested that the expression of the divergent paired loci, GLA and HNRNPH2, were controlled by BDP. Mutations in BDP may also serve a role in FD and may explain clinical disease diversity.
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Affiliation(s)
- Mohammed A Ibrahim Al-Obaide
- Department of Pediatrics, School of Medicine, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
| | - Ibtisam I Al-Obaidi
- Department of Pediatrics, School of Medicine, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
| | - Tetyana L Vasylyeva
- Department of Pediatrics, School of Medicine, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
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14
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[Fabry disease: A review]. Rev Med Interne 2020; 42:110-119. [PMID: 33172708 DOI: 10.1016/j.revmed.2020.08.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 02/03/2023]
Abstract
Fabry disease is the second most frequent lysosomal storage disorder. It is a X-linked genetic disease secondary to alpha-galactosidase A enzyme deficiency. This is a progressive and systemic disease that affects both males and females. Classical symptoms and organ involvements are acral pain crisis, cornea verticillata, hypertrophic cardiomyopathy, stroke and chronic kidney disease with proteinuria. Nevertheless, organ damages can be missing or pauci-symptomatic and other common symptoms are poorly recognised, such as gastrointestinal or ear involvement. In classical Fabry disease, symptoms first appear during childhood or teenage in males, but later in females. Patients may have non-classical or late-onset Fabry disease with delayed manifestations or with single-organ involvement. Recognition of Fabry disease is important because treatments are available, but it may be challenging. Diagnosis is easy in males, with dosage of alpha-galactosidase A enzyme activity into leukocytes, but more difficult in females who can express normal residual activity. Other plasmatic biomarkers, such as lyso-globotriaosylceramide (lyso-Gb3), are interesting in females, but need to be associated with GLA gene analysis. In this review, we aimed at summarize the main clinical manifestations of Fabry disease and propose a practical algorithm to know how to diagnose this complex disease.
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15
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Sawada T, Kido J, Sugawara K, Matsumoto S, Takada F, Tsuboi K, Ohtake A, Endo F, Nakamura K. Detection of novel Fabry disease-associated pathogenic variants in Japanese patients by newborn and high-risk screening. Mol Genet Genomic Med 2020; 8:e1502. [PMID: 33016649 PMCID: PMC7667298 DOI: 10.1002/mgg3.1502] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/13/2020] [Accepted: 08/30/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND In Japan, newborn and high-risk screening for Fabry disease (FD), an inherited X-linked disorder caused by GLA mutations, using dried blood spots was initiated in 2006. In newborn screening, 599,711 newborns were screened by December 2018, and 57 newborns from 54 families with 26 FD-associated variants were detected. In high-risk screening, 18,235 individuals who had symptoms and/or a family history of FD were screened by March 2019, and 236 individuals from 143 families with 101 FD-associated variants were detected. Totally 3, 116 variants were detected; 41 of these were not registered in Fabry-database.org or ClinVar and 33 were definitely novel. Herein, we report the clinical outcomes and discuss the pathogenicity of the 41 variants. METHODS We traced nine newborns and 46 individuals with the 33 novel variants, and nine newborns and 10 individuals with eight other variants not registered in the FD database, and analyzed the information on symptoms, treatments, and outcomes. RESULTS Thirty-eight of the 46 individuals with the 33 novel variants showed symptoms and received enzyme-replacement therapy and/or chaperone treatment. CONCLUSION Delayed diagnosis should be avoided in patients with FD. Our results will help clinicians diagnose FD and determine the appropriate treatment for patients with these variants.
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Affiliation(s)
- Takaaki Sawada
- Department of PediatricsGraduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Jun Kido
- Department of PediatricsGraduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Keishin Sugawara
- Department of PediatricsGraduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Shirou Matsumoto
- Department of PediatricsGraduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Fumio Takada
- Department of Medical Genetics and GenomicsKitasato University Graduate School of Medical SciencesKanagawaJapan
| | | | - Akira Ohtake
- Department of Pediatrics & Clinical GenomicsFaculty of MedicineSaitama Medical UniversitySaitamaJapan
| | - Fumio Endo
- Department of PediatricsGraduate School of Medical SciencesKumamoto UniversityKumamotoJapan
- Kumamoto‐Ezuko Medical Center for Disabled ChildrenKumamotoJapan
| | - Kimitoshi Nakamura
- Department of PediatricsGraduate School of Medical SciencesKumamoto UniversityKumamotoJapan
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Yoshida S, Kido J, Sawada T, Momosaki K, Sugawara K, Matsumoto S, Endo F, Nakamura K. Fabry disease screening in high-risk populations in Japan: a nationwide study. Orphanet J Rare Dis 2020; 15:220. [PMID: 32843101 PMCID: PMC7448968 DOI: 10.1186/s13023-020-01494-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 08/05/2020] [Indexed: 02/06/2023] Open
Abstract
Background Fabry disease (FD) is a X-linked inherited disorder caused by mutations in the GLA gene, which results in the deficiency of α-galactosidase A (α-Gal A). This leads to the progressive accumulation of metabolites, which can cause multisystemic dysfunction. A recent screening study among neonates reported an increase in the incidence of FD, and numerous FD patients remain undiagnosed or even misdiagnosed. Therefore, this study aimed to identify patients with FD by performing high-risk screening in 18,135 individuals, enrolled from October 2006 to March 2019, with renal, cardiac, or neurological manifestations from all prefectures in Japan. A total of 601 hospitals participated in this study. Results Low α-Gal A activity was detected in 846 individuals, with 224 of them diagnosed with FD by GLA sequencing. Cases with a family history of FD (n = 64) were also subjected to sequencing, without α-Gal A assay, as per individual request, and 12 of them were diagnosed with a variant of FD. A total of 236 patients with FD (97 males and 139 females) were identified from among 18,199 participants. A total of 101 GLA variants, including 26 novel variants, were detected in the 236 patients with FD from 143 families, with 39 amenable variants (39%) and 79 of the 236 patients (33%) suitable for migalastat treatment. Conclusions From among 18,199 participants, 101 GLA variants, including 26 novel variants, were identified in the 236 patients with FD from 143 families. Migalastat was identified as a suitable treatment option in 33% of the patients with FD and 39% of the GLA variants were detected as amenable. Therefore, the simple screening protocol using dried blood spots that was performed in this study could be useful for early diagnosis and selection of appropriate treatments for FD in high-risk and underdiagnosed patients with various renal, cardiac, or neurological manifestations.
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Affiliation(s)
- Shinichiro Yoshida
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan.,KM Biologics Co., Ltd., Kumamoto, Japan
| | - Jun Kido
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan.
| | - Takaaki Sawada
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan
| | - Ken Momosaki
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan.,Kumamoto-Ezuko Medical Center for Disabled Children, Kumamoto, Japan
| | - Keishin Sugawara
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan
| | - Shirou Matsumoto
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan
| | - Fumio Endo
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan.,Kumamoto-Ezuko Medical Center for Disabled Children, Kumamoto, Japan
| | - Kimitoshi Nakamura
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan
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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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18
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Germain DP, Oliveira JP, Bichet DG, Yoo HW, Hopkin RJ, Lemay R, Politei J, Wanner C, Wilcox WR, Warnock DG. Use of a rare disease registry for establishing phenotypic classification of previously unassigned GLA variants: a consensus classification system by a multispecialty Fabry disease genotype-phenotype workgroup. J Med Genet 2020; 57:542-551. [PMID: 32161151 PMCID: PMC7418626 DOI: 10.1136/jmedgenet-2019-106467] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/13/2019] [Accepted: 01/03/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Fabry disease (α-galactosidase deficiency) is an X-linked genetic disease caused by a variety of pathogenic GLA variants. The phenotypic heterogeneity is considerable, with two major forms, classic and later-onset disease, but adjudication of clinical phenotype is currently lacking for many variants. We aimed to determine consensus phenotypic classification for previously unclassified GLA variants from the GLA-specific fabry-database.org database. METHODS A Fabry disease genotype-phenotype workgroup developed a five-stage iterative system based on expert clinical assessment, published literature and clinical evidence of pathogenicity using a 2-point scoring system based on clinical hallmarks of classic disease. Kaplan-Meier (KM) analysis of severe clinical event-free survival was used as final validation. Results were compared with those from web-based disease databases and in silico pathogenicity prediction programmes. RESULTS Final consensus on classifications of 'pathogenic' was achieved for 32 of 33 GLA variants (26 'classic' phenotype, 171 males; 6 'later-onset' phenotype, 57 males). One variant remained of uncertain significance. KM curves were similar for the known fabry-database.org database phenotypes and when workgroup consensus classifications were added, and the curves retained the same separation between 'classic' and 'later-onset' phenotypes. CONCLUSION The iterative system implemented by a Fabry disease genotype-phenotype workgroup achieved phenotypic classifications for variants that were previously unclassified. Clinical pathogenicity associated with a particular GLA variant defined in affected males appears to have predictive value and also generally correlates with risk for affected females. The newly established classifications can be of benefit to the clinical care of Fabry patients harbouring these variants.
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Affiliation(s)
- Dominique P Germain
- French Referral Centre for Fabry disease, Division of Medical Genetics, University of Versailles, Paris-Saclay University, Montigny, France
| | - João Paulo Oliveira
- Department of Genetics, São João Hospital Centre & Faculty of Medicine, University of Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal
| | - Daniel G Bichet
- Nephrology Service, Research Center, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada.,Departments of Medicine, Pharmacology and Physiology, University of Montreal, Montreal, Québec, Canada
| | - Han-Wook Yoo
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea
| | - Robert J Hopkin
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Juan Politei
- Department of Neurology, Fundación Para el Estudio de Enfermedades Neurómetabolicas (FESEN), Buenos Aires, Argentina
| | - Christoph Wanner
- Division of Nephrology, University Clinic, University of Würzburg, Würzburg, Germany
| | - William R Wilcox
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David G Warnock
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Wanner C, Feldt-Rasmussen U, Jovanovic A, Linhart A, Yang M, Ponce E, Brand E, Germain DP, Hughes DA, Jefferies JL, Martins AM, Nowak A, Vujkovac B, Weidemann F, West ML, Ortiz A. Cardiomyopathy and kidney function in agalsidase beta-treated female Fabry patients: a pre-treatment vs. post-treatment analysis. ESC Heart Fail 2020; 7:825-834. [PMID: 32100468 PMCID: PMC7261571 DOI: 10.1002/ehf2.12647] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/20/2019] [Accepted: 01/27/2020] [Indexed: 11/07/2022] Open
Abstract
AIMS Long-term treatment effect studies in large female Fabry patient groups are challenging to design because of phenotype heterogeneity and lack of appropriate comparison groups, and have not been reported. We compared long-term cardiomyopathy and kidney function outcomes after agalsidase beta treatment with preceding treatment-naive outcomes. METHODS AND RESULTS Self-controlled pretreatment and post-treatment comparison (piecewise mixed linear modelling) included Fabry female patients ≥18 years at treatment initiation who received agalsidase beta (0.9-1.1 mg/kg every other week) for ≥2 years, with ≥2 pretreatment and ≥2 post-treatment outcome measurements during 10-year follow-up. Left ventricular posterior wall thickness (LVPWT)/interventricular septal thickness (IVST) and estimated glomerular filtration rate (eGFR, Chronic Kidney Disease Epidemiology Collaboration creatinine equation) analyses included 42 and 86 patients, respectively, aged 50.0 and 46.3 years at treatment initiation, respectively. LVPWT and IVST increased pretreatment (follow-up 3.5 years) but stabilized during 3.6 years of treatment (LVPWT: n = 38, slope difference [95% confidence interval (CI)] = -0.41 [-0.68, -0.15] mm/year, Ppre-post difference <0.01; IVST: n = 38, slope difference = -0.32 [-0.67, 0.02] mm/year, Ppre-post difference = 0.07). These findings were not modified by renal involvement or antiproteinuric agent use. Compared with the treatment-naive period (follow-up 3.6 years), eGFR decline remained modest and stabilized within normal ranges during 4.1 years of treatment (slope difference, 95% CI: -0.13 [-1.15, 0.89] mL/min/1.73m2 /year, Ppre-post difference = 0.80). CONCLUSIONS Cardiac hypertrophy, progressing during pretreatment follow-up, appeared to stabilize during sustained agalsidase beta treatment. eGFR decline remained within normal ranges. This suggests that treatment may prevent further Fabry-related progression of cardiomyopathy in female patients and maintain normal kidney function.
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Affiliation(s)
- Christoph Wanner
- Department of Medicine, Division of Nephrology, University Hospital Würzburg, Würzburg, Germany
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ana Jovanovic
- The Mark Holland Unit, Department of Endocrinology and Metabolic Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Aleš Linhart
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - Meng Yang
- Epidemiology & Biostatistics, Sanofi Genzyme, Cambridge, MA, USA
| | - Elvira Ponce
- Global Medical Affairs Rare Diseases, Sanofi Genzyme, Cambridge, MA, USA
| | - Eva Brand
- Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, University Hospital Münster, Münster, Germany
| | - Dominique P Germain
- French Referral Center for Fabry Disease, Division of Medical Genetics and INSERM U1179, University of Versailles, Paris-Saclay University, Montigny, France
| | - Derralynn A Hughes
- Lysosomal Storage Disorder Unit, Royal Free London NHS Foundation Trust and, University College London, London, UK
| | - John L Jefferies
- Department of Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ana Maria Martins
- Department of Paediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - Albina Nowak
- Department of Internal Medicine, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Bojan Vujkovac
- Department of Internal Medicine, General Hospital Slovenj Gradec, Slovenj Gradec, Slovenia
| | - Frank Weidemann
- Medical Clinic I, Klinikum Vest, Knappschaftskrankenhaus, Recklinghausen, Germany
| | - Michael L West
- Department of Medicine, Division of Nephrology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alberto Ortiz
- Unidad de Dialisis, IIS-Fundación Jiménez Díaz, UAM, IRSIN, REDINREN, Madrid, Spain
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20
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Newborn screening for Fabry disease in the western region of Japan. Mol Genet Metab Rep 2020; 22:100562. [PMID: 31956509 PMCID: PMC6961758 DOI: 10.1016/j.ymgmr.2019.100562] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 12/27/2019] [Accepted: 12/29/2019] [Indexed: 01/02/2023] Open
Abstract
Newborn screening (NBS) for Fabry disease (FD) is the best way to detect FD early prior to presentation of symptoms and is currently implemented in Taiwan and several states such as Illinois, Missouri, and Tennessee in the United States of America. In this report, we provide data from the first large-scale NBS program for FD in Japan. From August 2006 to December 2018, 599,711 newborns were screened; 26 variants, including 15 pathogenic variants and 11 variants of uncertain significance (VOUS; including eight novel variants), were detected in 57 newborns. Twenty-six male and 11 female newborns with pathogenic variants were diagnosed as hemizygous and heterozygous patients, respectively. Thirteen male and seven female newborns with VOUS were diagnosed as potential hemizygous and potential heterozygous patients, respectively. At the most recent follow up, three of 26 hemizygous patients had manifested symptoms and were receiving enzyme replacement therapy. The other patients were being followed up by clinicians. The frequency of FD (pathogenic variants + VOUS) in this study was estimated to be 1:7683, whereas that of patients with pathogenic variants was 1:11,854. In the future, the NBS system for FD may contribute to the detection of newborns not presenting manifestations related to FD and adults who have or have not developed manifestations related to FD.
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21
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Suzuki H, Kurosawa K, Fukuda K, Ijima K, Sumazaki R, Saito S, Kosaki R, Hirasawa A, Okazaki Y, Imai K, Matsunaga T, Iwata T, Kosaki K. Japanese pathogenic variant database: DPV. ACTA ACUST UNITED AC 2018. [DOI: 10.3233/trd-180027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Hisato Suzuki
- Center for Medical Genetics, Keio University School of Medicine, Tokyo, Japan
| | - Kenji Kurosawa
- Division of Medical Genetics, Kanagawa Children’s Medical Center, Yokohama, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kazumoto Ijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryo Sumazaki
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shinji Saito
- Department of Pediatrics, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Rika Kosaki
- Division of Medical Genetics, National Center for Child Health and Development, Tokyo, Japan
| | - Akira Hirasawa
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Yasushi Okazaki
- Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Kohsuke Imai
- Department of Pediatrics Perinatal and Maternal Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tatsuo Matsunaga
- National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Takeshi Iwata
- National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Kenjiro Kosaki
- Center for Medical Genetics, Keio University School of Medicine, Tokyo, Japan
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Challenging popular tools for the annotation of genetic variations with a real case, pathogenic mutations of lysosomal alpha-galactosidase. BMC Bioinformatics 2018; 19:433. [PMID: 30497360 PMCID: PMC6266955 DOI: 10.1186/s12859-018-2416-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Severity gradation of missense mutations is a big challenge for exome annotation. Predictors of deleteriousness that are most frequently used to filter variants found by next generation sequencing, produce qualitative predictions, but also numerical scores. It has never been tested if these scores correlate with disease severity. Results wANNOVAR, a popular tool that can generate several different types of deleteriousness-prediction scores, was tested on Fabry disease. This pathology, which is caused by a deficit of lysosomal alpha-galactosidase, has a very large genotypic and phenotypic spectrum and offers the possibility of associating a quantitative measure of the damage caused by mutations to the functioning of the enzyme in the cells. Some predictors, and in particular VEST3 and PolyPhen2 provide scores that correlate with the severity of lysosomal alpha-galactosidase mutations in a statistically significant way. Conclusions Sorting disease mutations by severity is possible and offers advantages over binary classification. Dataset for testing and training in silico predictors can be obtained by transient transfection and evaluation of residual activity of mutants in cell extracts. This approach consents to quantitative data for severe, mild and non pathological variants. Electronic supplementary material The online version of this article (10.1186/s12859-018-2416-7) contains supplementary material, which is available to authorized users.
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Kummer KK, Kalpachidou T, Mitrić M, Langeslag M, Kress M. Altered Gene Expression in Prefrontal Cortex of a Fabry Disease Mouse Model. Front Mol Neurosci 2018; 11:201. [PMID: 30013462 PMCID: PMC6036252 DOI: 10.3389/fnmol.2018.00201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/18/2018] [Indexed: 11/13/2022] Open
Abstract
Fabry disease is an X-chromosome linked hereditary disease that is caused by loss of function mutations in the α-galactosidase A (α-Gal A) gene, resulting in defective glycolipid degradation and subsequent accumulation of globotriaosylceramide (Gb3) in different tissues, including vascular endothelial cells and neurons in the peripheral and central nervous system. We recently reported a differential gene expression profile of α-Gal A(−/0) mouse dorsal root ganglia, an established animal model of Fabry disease, thereby providing new gene targets that might underlie the neuropathic pain related symptoms. To investigate the cognitive symptoms experienced by Fabry patients, we performed one-color based hybridization microarray expression profiling of prefrontal cortex samples from adult α-Gal A(−/0) mice and age-matched wildtype controls, followed by protein-protein interaction and pathway analyses for the differentially regulated mRNAs. We found that from a total of 381 differentially expressed genes, 135 genes were significantly upregulated, whereas 246 genes were significantly downregulated between α-Gal A(−/0) mice and wildtype controls. Enrichment analysis for downregulated genes revealed mainly immune related pathways, including immune/defense responses, regulation of cytokine production, as well as signaling and transport regulation pathways. Further analysis of the regulated genes revealed a large number of genes involved in neurodegeneration. The current analysis for the first time presents a differential gene expression profile of central nervous system tissue from α-Gal A(−/0) mice, thereby providing novel knowledge on the deregulation and a possible contribution of gene expression to Fabry disease related brain pathologies.
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Affiliation(s)
- Kai K Kummer
- Division of Physiology, Department of Physiology and Medical Physics Medical, University of Innsbruck, Innsbruck, Austria
| | - Theodora Kalpachidou
- Division of Physiology, Department of Physiology and Medical Physics Medical, University of Innsbruck, Innsbruck, Austria
| | - Miodrag Mitrić
- Division of Physiology, Department of Physiology and Medical Physics Medical, University of Innsbruck, Innsbruck, Austria
| | - Michiel Langeslag
- Division of Physiology, Department of Physiology and Medical Physics Medical, University of Innsbruck, Innsbruck, Austria
| | - Michaela Kress
- Division of Physiology, Department of Physiology and Medical Physics Medical, University of Innsbruck, Innsbruck, Austria
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Kummer KK, Kalpachidou T, Kress M, Langeslag M. Signatures of Altered Gene Expression in Dorsal Root Ganglia of a Fabry Disease Mouse Model. Front Mol Neurosci 2018; 10:449. [PMID: 29422837 PMCID: PMC5788883 DOI: 10.3389/fnmol.2017.00449] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/22/2017] [Indexed: 12/19/2022] Open
Abstract
Fabry disease is an X-linked lysosomal storage disorder with involvement of the nervous system. Accumulation of glycosphingolipids within peripheral nerves and/or dorsal root ganglia results in pain due to small-fiber neuropathy, which affects the majority of patients already in early childhood. The α-galactosidase A deficient mouse proved to be an adequate model for Fabry disease, as it shares many symptoms including altered temperature sensitivity and pain perception. To characterize the signatures of gene expression that might underlie Fabry disease-associated sensory deficits and pain, we performed one-color based hybridization microarray expression profiling of DRG explants from adult α-galactosidase A deficient mice and age-matched wildtype controls. Protein-protein interaction (PPI) and pathway analyses were performed for differentially regulated mRNAs. We found 812 differentially expressed genes between adult α-galactosidase A deficient mice and age-matched wildtype controls, 506 of them being upregulated, and 306 being downregulated. Among the enriched pathways and processes, the disease-specific pathways “lysosome” and “ceramide metabolic process” were identified, enhancing reliability of the current analysis. Novel pathways that we identified include “G-protein coupled receptor signaling” and “retrograde transport” for the upregulated genes. From the analysis of downregulated genes, immune-related pathways, autoimmune, and infection pathways emerged. The current analysis is the first to present a differential gene expression profile of DRGs from α-galactosidase A deficient mice, thereby providing knowledge on possible mechanisms underlying neuropathic pain related symptoms in Fabry patients. Therefore, the presented data provide new insights into the development of the pain phenotype and might lead to new treatment strategies.
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Affiliation(s)
- Kai K Kummer
- Division of Physiology, Department of Physiology and Medical Physics, Medical University of Innsbruck, Innsbruck, Austria
| | - Theodora Kalpachidou
- Division of Physiology, Department of Physiology and Medical Physics, Medical University of Innsbruck, Innsbruck, Austria
| | - Michaela Kress
- Division of Physiology, Department of Physiology and Medical Physics, Medical University of Innsbruck, Innsbruck, Austria
| | - Michiel Langeslag
- Division of Physiology, Department of Physiology and Medical Physics, Medical University of Innsbruck, Innsbruck, Austria
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Pasqualim G, Dos Santos BA, Giugliani R, Matte U. Simple and efficient screening of patients with Fabry disease with high resolution melting. Clin Biochem 2018; 53:160-163. [PMID: 29305833 DOI: 10.1016/j.clinbiochem.2018.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 01/02/2018] [Accepted: 01/02/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fabry disease (FD [MIM: 301500]) is a disorder caused by mutations in the alpha-galactosidase gene (GLA), which presents great allelic heterogeneity. The development of fast screening methods may reduce costs and length of diagnosis, being particularly important for screening programs of high-risk female patients. Therefore, the purpose of this study was to develop a pre-sequencing genetic screening method based on high resolution melting (HRM) analysis. METHODS We performed HRM analysis in one hundred and three individuals, 79 females and 24 males, with a total of 27 different variants in 30 different genotypes. We standardized a protocol using EvaGreen, a release-on-demand dye specific for HRM, added to the PCR reaction. Amplification was performed in a conventional real-time system with HRM capability. RESULTS All genotypes in all amplicons were distinguishable from wild type. In most amplicons it was even possible to differentiate each genotype from the others. CONCLUSION We developed a simple, fast and highly sensitive HRM based protocol that may facilitate genetic screening of FD.
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Affiliation(s)
- Gabriela Pasqualim
- Post-Graduation Program on Genetics and Molecular Biology, UFRGS, Porto Alegre, RS 91501-970, Brazil; Gene Therapy Center, Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS 90035-903, Brazil
| | - Bruna Almeida Dos Santos
- Gene Therapy Center, Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS 90035-903, Brazil
| | - Roberto Giugliani
- Post-Graduation Program on Genetics and Molecular Biology, UFRGS, Porto Alegre, RS 91501-970, Brazil; Gene Therapy Center, Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS 90035-903, Brazil; Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS 90035-903, Brazil; Department of Genetics, UFRGS, Porto Alegre, RS 91501-970, Brazil; INAGEMP, Porto Alegre, RS 90035-903, Brazil
| | - Ursula Matte
- Post-Graduation Program on Genetics and Molecular Biology, UFRGS, Porto Alegre, RS 91501-970, Brazil; Gene Therapy Center, Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS 90035-903, Brazil; Department of Genetics, UFRGS, Porto Alegre, RS 91501-970, Brazil.
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E-Learning for Rare Diseases: An Example Using Fabry Disease. Int J Mol Sci 2017; 18:ijms18102049. [PMID: 28946642 PMCID: PMC5666731 DOI: 10.3390/ijms18102049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 12/23/2022] Open
Abstract
Background: Rare diseases represent a challenge for physicians because patients are rarely seen, and they can manifest with symptoms similar to those of common diseases. In this work, genetic confirmation of diagnosis is derived from DNA sequencing. We present a tutorial for the molecular analysis of a rare disease using Fabry disease as an example. Methods: An exonic sequence derived from a hypothetical male patient was matched against human reference data using a genome browser. The missense mutation was identified by running BlastX, and information on the affected protein was retrieved from the database UniProt. The pathogenic nature of the mutation was assessed with PolyPhen-2. Disease-specific databases were used to assess whether the missense mutation led to a severe phenotype, and whether pharmacological therapy was an option. Results: An inexpensive bioinformatics approach is presented to get the reader acquainted with the diagnosis of Fabry disease. The reader is introduced to the field of pharmacological chaperones, a therapeutic approach that can be applied only to certain Fabry genotypes. Conclusion: The principle underlying the analysis of exome sequencing can be explained in simple terms using web applications and databases which facilitate diagnosis and therapeutic choices.
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Wilson HC, Hopkin RJ, Madueme PC, Czosek RJ, Bailey LA, Taylor MD, Jefferies JL. Arrhythmia and Clinical Cardiac Findings in Children With Anderson-Fabry Disease. Am J Cardiol 2017; 120:251-255. [PMID: 28550929 DOI: 10.1016/j.amjcard.2017.04.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 04/18/2017] [Accepted: 04/18/2017] [Indexed: 12/15/2022]
Abstract
Anderson-Fabry Disease (AFD) is a lysosomal storage disorder that results in progressive cardiovascular hypertrophy, scarring, and arrhythmia burden; yet, the early cardiac phenotype of AFD is still poorly defined. To further characterize early cardiac features in AFD, we evaluated electrocardiographic and clinical findings contained in a local cohort of pediatric AFD patients and arrhythmia data in children enrolled in the Fabry Registry. Twenty-six local patients aged <18 years were identified (average age 9.7 ± 3.8 years, n = 12 males). Sinus bradycardia was the most frequent rhythm abnormality (23%), followed by ectopic atrial rhythm (12%) and premature atrial contractions (8%). No PR, QRS, or QTc intervals were prolonged. First-degree atrioventricular block developed in 1 female during follow-up. Chest pain (35%) and palpitations (23%) were highly prevalent complaints in clinical follow-up and did not differ significantly between genders. Structural findings included aortic root dilation in 3 patients and concurrent aortic insufficiency in 1. Among 593 patients aged < 18 years with electrocardiographic data identified in the Fabry Registry, sinus bradycardia, defined as heart rate <60 beats per minute per registry guidelines, was the most common arrhythmia (12.3%). In conclusion, clinical findings and subtle abnormalities of conduction, rhythm, and structure point toward a heterogeneous inception of Fabry cardiomyopathy. Bradycardia, common in adults, is frequent even among children with AFD. Given the potential for early initiation of enzyme replacement therapy to reduce cardiovascular morbidity, continued work to develop paradigms of therapy and longitudinal cardiovascular surveillance is warranted.
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Sanchez-Niño MD, Ortiz A. Enzyme Replacement Therapy for Fabry Disease. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2016. [DOI: 10.1177/2326409816679428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Alberto Ortiz
- Dialysis Unit, IIS-Fundación Jiménez Díaz, UAM, REDINREN, FRIAT, Madrid, Spain
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29
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Yeniçerioğlu Y, Akdam H, Dursun B, Alp A, Sağlam Eyiler F, Akın D, Gün Y, Hüddam B, Batmazoğlu M, Gibyeli Genek D, Pirinççi S, Ersoy İR, Üzüm A, Soypaçacı Z, Tanrısev M, Çolak H, Demiral Sezer S, Bozkurt G, Akyıldız UO, Akyüz Ünsal Aİ, Ünübol M, Uslu M, Eryılmaz U, Günel C, Meteoğlu İ, Yavaşoğlu İ, Ünsal A, Akar H, Okyay P. Screening Fabry's disease in chronic kidney disease patients not on dialysis: a multicenter study. Ren Fail 2016; 39:104-111. [PMID: 27832731 PMCID: PMC6014365 DOI: 10.1080/0886022x.2016.1254656] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Fabry's disease is an X-linked inherited, rare, progressive, lysosomal storage disorder, affecting multiple organs due to the deficient activity of α-galactosidase A (α-Gal A) enzyme. The prevalence has been reported to be 0.15-1% in hemodialysis patients; however, the information on the prevalence in chronic kidney disease not on dialysis is lacking. This study aimed to determine the prevalence of Fabry's disease in chronic kidney disease. METHODS The patients older than 18 years, enclosing KDIGO 2012 chronic kidney disease definitions, not on dialysis, were enrolled. Dried blood spots on Guthrie papers were used to analyze α-Gal A enzyme and genetic analysis was performed in individuals with enzyme activity ≤1.2 μmol/L/h. RESULTS A total of 1453 chronic kidney disease patients not on dialysis from seven clinics in Turkey were screened. The mean age of the study population was 59.3 ± 15.9 years. 45.6% of patients were female. The creatinine clearance of 77.3% of patients was below 60 mL/min/1.73 m2, 8.4% had proteinuria, and 2.5% had isolated microscopic hematuria. The mean value of patients' α-Gal A enzyme was detected as 2.93 ± 1.92 μmol/L/h. 152 patients had low levels of α-Gal A enzyme activity (≤1.2 μmol/L/h). In mutation analysis, A143T and D313Y variants were disclosed in three male patients. The prevalence of Fabry's disease in chronic kidney disease not on dialysis was found to be 0.2% (0.4% in male, 0.0% in female). CONCLUSION Fabry's disease should be considered in the differential diagnosis of chronic kidney disease with unknown etiology even in the absence of symptoms and signs suggestive of Fabry's disease.
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Affiliation(s)
- Yavuz Yeniçerioğlu
- a Department of Internal Medicine, Division of Nephrology , Adnan Menderes University School of Medicine , Aydın , Turkey
| | - Hakan Akdam
- a Department of Internal Medicine, Division of Nephrology , Adnan Menderes University School of Medicine , Aydın , Turkey
| | - Belda Dursun
- b Department of Internal Medicine, Division of Nephrology , Pamukkale University School of Medicine , Denizli , Turkey
| | - Alper Alp
- a Department of Internal Medicine, Division of Nephrology , Adnan Menderes University School of Medicine , Aydın , Turkey
| | | | - Davut Akın
- d Denizli State Hospital Nephrology , Denizli , Turkey
| | - Yelda Gün
- c Aydın State Hospital Nephrology , Aydın , Turkey
| | - Bülent Hüddam
- e Department of Nephrology , Muğla Sıtkı Koçman University Education and Research Hospital , Muğla , Turkey
| | | | - Dilek Gibyeli Genek
- e Department of Nephrology , Muğla Sıtkı Koçman University Education and Research Hospital , Muğla , Turkey
| | - Serhat Pirinççi
- f Department of Public Health , Adnan Menderes University School of Medicine , Aydın , Turkey
| | - İsmail Rıfkı Ersoy
- g Department of Nephrology, İzmir Katip Çelebi University Education and Research Hospital , İzmir , Turkey
| | - Atilla Üzüm
- g Department of Nephrology, İzmir Katip Çelebi University Education and Research Hospital , İzmir , Turkey
| | - Zeki Soypaçacı
- g Department of Nephrology, İzmir Katip Çelebi University Education and Research Hospital , İzmir , Turkey
| | - Mehmet Tanrısev
- h Department of Nephrology , İzmir Tepecik Education and Research Hospital Internal Medicine , İzmir , Turkey
| | - Hülya Çolak
- h Department of Nephrology , İzmir Tepecik Education and Research Hospital Internal Medicine , İzmir , Turkey
| | - Sibel Demiral Sezer
- h Department of Nephrology , İzmir Tepecik Education and Research Hospital Internal Medicine , İzmir , Turkey
| | - Gökay Bozkurt
- i Department of Genetics , Adnan Menderes University School of Medicine , Aydın , Turkey
| | - Utku Oğan Akyıldız
- j Department of Neurology , Adnan Menderes University School of Medicine , Aydın , Turkey
| | - Ayşe İpek Akyüz Ünsal
- k Department of Ophthalmology , Adnan Menderes University School of Medicine , Aydın , Turkey
| | - Mustafa Ünübol
- l Department of Internal Medicine, Division of Endocrinology , Adnan Menderes University School of Medicine , Aydın , Turkey
| | - Meltem Uslu
- m Department of Dermatology , Adnan Menderes University School of Medicine , Aydın , Turkey
| | - Ufuk Eryılmaz
- n Department of Cardiology , Adnan Menderes University School of Medicine , Aydın , Turkey
| | - Ceren Günel
- o Department of Otorhinolaryngology , Adnan Menderes University School of Medicine , Aydın , Turkey
| | - İbrahim Meteoğlu
- p Department of Pathology , Adnan Menderes University School of Medicine , Aydın , Turkey
| | - İrfan Yavaşoğlu
- q Department of Internal Medicine, Division of Hematology , Adnan Menderes University School of Medicine , Aydın , Turkey
| | - Alparslan Ünsal
- r Department of Radiology , Adnan Menderes University School of Medicine , Aydın , Turkey
| | - Harun Akar
- h Department of Nephrology , İzmir Tepecik Education and Research Hospital Internal Medicine , İzmir , Turkey
| | - Pınar Okyay
- f Department of Public Health , Adnan Menderes University School of Medicine , Aydın , Turkey
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Saito S, Ohno K, Okuyama T, Sakuraba H. Structural Basis of Mucopolysaccharidosis Type II and Construction of a Database of Mutant Iduronate 2-Sulfatases. PLoS One 2016; 11:e0163964. [PMID: 27695081 PMCID: PMC5047593 DOI: 10.1371/journal.pone.0163964] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/16/2016] [Indexed: 11/20/2022] Open
Abstract
Mucopolysaccharidosis type II (MPS II, Hunter syndrome) is an X-linked genetic disorder caused by a deficiency of iduronate 2-sulfatase (IDS), and missense mutations comprising about 30% of the mutations responsible for MPS II result in heterogeneous phenotypes ranging from the severe to the attenuated form. To elucidate the basis of MPS II from the structural viewpoint, we built structural models of the wild type and mutant IDS proteins resulting from 131 missense mutations (phenotypes: 67 severe and 64 attenuated), and analyzed the influence of each amino acid substitution on the IDS structure by calculating the accessible surface area, the number of atoms affected and the root-mean-square distance. The results revealed that the amino acid substitutions causing MPS II were widely spread over the enzyme molecule and that the structural changes of the enzyme protein were generally larger in the severe group than in the attenuated one. Coloring of the atoms influenced by different amino acid substitutions at the same residue showed that the structural changes influenced the disease progression. Based on these data, we constructed a database of IDS mutations as to the structures of mutant IDS proteins.
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Affiliation(s)
- Seiji Saito
- Department of Medical Management and Informatics, Hokkaido Information University, 59–2 Nishinopporo, Ebetsu, Hokkaido 069–8585, Japan
| | - Kazuki Ohno
- Catalyst Inc., 1-5-6 Kudan-minami, Chiyoda-ku, Tokyo 102–0074, Japan
- Education Academy of Computational Life Sciences, Tokyo Institute of Technology, 2-12-1 Ookayama Meguro-ku, Tokyo 152–8552, Japan
| | - Torayuki Okuyama
- Department of Clinical Laboratory Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157–8535, Japan
| | - Hitoshi Sakuraba
- Department of Clinical Genetics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204–8588, Japan
- * E-mail:
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Kaneski CR, Brady RO, Hanover JA, Schueler UH. Development of a model system for neuronal dysfunction in Fabry disease. Mol Genet Metab 2016; 119:144-50. [PMID: 27471012 PMCID: PMC5031533 DOI: 10.1016/j.ymgme.2016.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 07/21/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
Fabry disease is a glycosphingolipid storage disorder that is caused by a genetic deficiency of the enzyme alpha-galactosidase A (AGA, EC 3.2.1.22). It is a multisystem disease that affects the vascular, cardiac, renal, and nervous systems. One of the hallmarks of this disorder is neuropathic pain and sympathetic and parasympathetic nervous dysfunction. The exact mechanism by which changes in AGA activity result in change in neuronal function is not clear, partly due to of a lack of relevant model systems. In this study, we report the development of an in vitro model system to study neuronal dysfunction in Fabry disease by using short-hairpin RNA to create a stable knock-down of AGA in the human cholinergic neuronal cell line, LA-N-2. We show that gene-silenced cells show specifically reduced AGA activity and store globotriaosylceramide. In gene-silenced cells, release of the neurotransmitter acetylcholine is significantly reduced, demonstrating that this model may be used to study specific neuronal functions such as neurotransmitter release in Fabry disease.
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Affiliation(s)
- Christine R Kaneski
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Roscoe O Brady
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - John A Hanover
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ulrike H Schueler
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
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Hopkin RJ, Cabrera G, Charrow J, Lemay R, Martins AM, Mauer M, Ortiz A, Patel MR, Sims K, Waldek S, Warnock DG, Wilcox WR. Risk factors for severe clinical events in male and female patients with Fabry disease treated with agalsidase beta enzyme replacement therapy: Data from the Fabry Registry. Mol Genet Metab 2016; 119:151-9. [PMID: 27510433 DOI: 10.1016/j.ymgme.2016.06.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/10/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Fabry disease, an X-linked lysosomal storage disorder, causes intracellular accumulation of glycosphingolipids leading to progressive renal, cardiovascular, and cerebrovascular disease, and premature death. METHODS This longitudinal Fabry Registry study analyzed data from patients with Fabry disease to determine the incidence and type of severe clinical events following initiation of enzyme replacement therapy (ERT) with agalsidase beta, as well as risk factors associated with occurrence of these events. Severe events assessed included chronic dialysis, renal transplantation, cardiac events, stroke, and death. RESULTS The analyses included 969 male and 442 female Fabry patients. The mean age at first agalsidase beta infusion was 35 and 44, and median treatment follow-up 4.3years and 3.2years, respectively. Among males, cardiac events were the most common on-ERT events, followed by renal, stroke, and non-cardiac death. Among females, cardiac events were also most common followed by stroke and renal events. Patients with on-ERT events had significantly more advanced cardiac and renal disease at baseline as compared with patients without on-ERT events. Severe events were also associated with older age at ERT initiation (males and females), a history of pre-ERT events (females; approaching statistical significance in males), and a higher urinary protein/creatinine ratio (females). Approximately 65% of patients with pre-ERT events did not experience subsequent on-ERT events. Of patients without pre-ERT events, most (84% of males, 92% of females) remained event-free. CONCLUSIONS Patients with on-ERT severe events had more advanced Fabry organ involvement at baseline than those without such events and patients who initiated ERT at a younger age had less residual risk of on-ERT events. The observed patterns of residual risk may aid clinicians in multidisciplinary monitoring of male and female patients with Fabry disease receiving ERT, and in determining the need for administration of adjunctive therapies.
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Affiliation(s)
- Robert J Hopkin
- Cincinnati Children's Hospital Medical Center, Cincinnati, USA; Department of Pediatrics, University of Cincinnati College Medicine, Cincinnati, USA.
| | | | - Joel Charrow
- Division of Genetics, Birth Defects and Metabolism, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, USA.
| | - Roberta Lemay
- Strategic Epidemiology & Biostatistics, Rare Diseases, Sanofi Genzyme, Cambridge, USA.
| | - Ana Maria Martins
- Reference Center for Inborn Errors of Metabolism, Federal University of São Paulo, São Paulo, Brazil.
| | - Michael Mauer
- Departments of Pediatrics and Medicine, University of Minnesota, Minneapolis, USA.
| | - Alberto Ortiz
- Unidad de Dialisis, IIS-Fundacion Jimenez Diaz, School of Medicine, UAM, IRSIN, REDINREN, Madrid, Spain.
| | - Manesh R Patel
- Division of Cardiovascular Medicine, Duke University School of Medicine, Durham, USA.
| | - Katherine Sims
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
| | | | - David G Warnock
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, USA.
| | - William R Wilcox
- Division of Medical Genetics, Department of Human Genetics, Emory University School of Medicine, Atlanta, USA.
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Ortiz A, Abiose A, Bichet DG, Cabrera G, Charrow J, Germain DP, Hopkin RJ, Jovanovic A, Linhart A, Maruti SS, Mauer M, Oliveira JP, Patel MR, Politei J, Waldek S, Wanner C, Yoo HW, Warnock DG. Time to treatment benefit for adult patients with Fabry disease receiving agalsidase β: data from the Fabry Registry. J Med Genet 2016; 53:495-502. [PMID: 26993266 PMCID: PMC4941144 DOI: 10.1136/jmedgenet-2015-103486] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 02/23/2016] [Indexed: 11/29/2022]
Abstract
Background Agalsidase β is a form of enzyme replacement therapy for Fabry disease, a genetic disorder characterised by low α-galactosidase A activity, accumulation of glycosphingolipids and life-threatening cardiovascular, renal and cerebrovascular events. In clinical trials, agalsidase β cleared glycolipid deposits from endothelial cells within 6 months; clearance from other cell types required sustained treatment. We hypothesised that there might be a ‘lag time’ to clinical benefit after initiating agalsidase β treatment, and analysed the incidence of severe clinical events over time in patients receiving agalsidase β. Methods The incidence of severe clinical events (renal failure, cardiac events, stroke, death) was studied in 1044 adult patients (641 men, 403 women) enrolled in the Fabry Registry who received agalsidase β (average dose 1 mg/kg every 2 weeks) for up to 5 years. Results The incidence of all severe clinical events was 111 per 1000 person-years (95% CI 84 to 145) during the first 6 months. After 6 months, the incidence decreased and remained stable within the range of 40–58 events per 1000 patient-years. The largest decrease in incidence rates was among male patients and those aged ≥40 years when agalsidase β was initiated. Conclusions Contrary to the expected increased incidence of severe clinical events with time, adult patients with Fabry disease had decreased incidence of severe clinical events after 6 months treatment with agalsidase β 1 mg/kg every 2 weeks. Trial registration number NCT00196742.
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Affiliation(s)
- Alberto Ortiz
- Unidad de Dialisis, IIS-Fundacion Jimenez Diaz/UAM, IRSIN, Madrid, Spain
| | | | - Daniel G Bichet
- Hôpital du Sacré-Coeur de Montréal and University of Montreal, Montreal, QC, Canada
| | | | - Joel Charrow
- Division of Genetics, Birth Defects, and Metabolism, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dominique P Germain
- Division of Medical Genetics, University of Versailles-St Quentin en Yvelines, Versailles, France Assistance Publique-Hôpitaux de Paris, Garches, France
| | - Robert J Hopkin
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ana Jovanovic
- Department of Endocrinology and Metabolic Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Aleš Linhart
- Department of Internal Medicine, School of Medicine, Charles University, Prague, Czech Republic
| | - Sonia S Maruti
- Genzyme, a Sanofi Company, Cambridge, Massachusetts, USA
| | - Michael Mauer
- Departments of Pediatrics and Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - João P Oliveira
- Department of Genetics, São João Hospital Centre & Faculty of Medicine, University of Porto, Porto, Portugal I3S-Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - Manesh R Patel
- Division of Cardiovascular Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Juan Politei
- Department of Neurology, Fundacion Para el Estudio de Enfermedades Neurometabolicas (FESEN), Buenos Aires, Argentina
| | | | - Christoph Wanner
- Division of Nephrology, University Clinic, University of Würzburg, Würzburg, Germany
| | - Han-Wook Yoo
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - David G Warnock
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Boutin M, Auray-Blais C. Metabolomic discovery of novel urinary galabiosylceramide analogs as Fabry disease biomarkers. JOURNAL OF THE AMERICAN SOCIETY FOR MASS SPECTROMETRY 2015; 26:499-510. [PMID: 25582508 DOI: 10.1007/s13361-014-1060-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 11/25/2014] [Accepted: 11/25/2014] [Indexed: 06/04/2023]
Abstract
Fabry disease is an X-linked, complex, multisystemic lysosomal storage disorder presenting marked phenotypic and genotypic variability among affected male and female patients. Glycosphingolipids, mainly globotriaosylceramide (Gb(3)) isoforms/analogs, globotriaosylsphingosine (lyso-Gb(3)) and analogs, as well as galabiosylceramide (Ga(2)) isoforms/analogs accumulate in the vascular endothelium, nerves, cardiomyocytes, renal glomerular and tubular epithelial cells, and biological fluids. The search for biomarkers reflecting disease severity and progression is still on-going. A metabolomic study using quadrupole time-of-flight mass spectrometry has revealed 22 galabiosylceramide isoforms/analogs in urine of untreated Fabry patients classified in seven groups according to their chemical structure: (1) Saturated fatty acid; (2) one extra double bond; (3) two extra double bonds; (4) hydroxylated saturated fatty acid; (5) hydroxylated fatty acid and one extra double bond; (6) hydrated sphingosine and hydroxylated fatty acid; (7) methylated amide linkage. Relative quantification of both Ga(2) and Gb(3) isoforms/analogs was performed. All these biomarkers are significantly more abundant in urine samples from untreated Fabry males compared with healthy male controls. A significant amount of Ga(2) isoforms/analogs, accounting for 18% of all glycosphingolipids analyzed (Ga(2) + Gb(3) and respective isoforms/analogs), were present in urine of Fabry patients. Gb(3) isoforms containing saturated fatty acids are the most abundant (60.9%) compared with 26.3% for Ga(2). A comparison between Ga(2) isoforms/analogs and their Gb(3) counterparts also showed that the proportion of analogs with hydroxylated fatty acids is significantly greater for Ga(2) (35.8%) compared with Gb(3) (1.9%). These results suggest different biological pathways involved in the synthesis and/or degradation of Gb(3) and Ga(2) metabolites.
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Affiliation(s)
- Michel Boutin
- Division of Medical Genetics, Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12th Avenue North, Quebec, J1H 5N4, Canada
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Neto NSR. Identification and Clinical Characterization of a Novel Alpha-Galactosidase A Mutation. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2014. [DOI: 10.1177/2326409814554700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ross LF. Newborn screening for lysosomal storage diseases: an ethical and policy analysis. J Inherit Metab Dis 2012; 35:627-34. [PMID: 22189599 DOI: 10.1007/s10545-011-9435-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 11/26/2011] [Accepted: 12/01/2011] [Indexed: 10/14/2022]
Abstract
The traditional focus of newborn screening (NBS) is testing infants for medical conditions like phenylketonuria (PKU) that may cause significant morbidity or mortality unless treatment is initiated early. Although the Wilson and Jungner criteria were not designed specifically for NBS, the public health screening criteria have been used, with some modifications, to justify what conditions are included in a universal NBS panel. These criteria are being challenged by platform technologies like tandem mass spectrometry (MS/MS) that allow for the identification of numerous conditions on a single sample because they identify many conditions and variants simultaneously, some of which meet and others which fail to meet the criteria. In this manuscript, I evaluate three lysosomal storage diseases included in this multiplex screening test-Pompe disease, Fabry disease, and Krabbe disease. I show that they fail to meet some of the critical Wilson and Jungner criteria and thus are not ready for inclusion in universal NBS panels. Rather, screening for these conditions should only be performed in the research context with institutional review board approval and parental permission.
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X-inactivation in Fabry disease. Gene 2012; 505:266-8. [PMID: 22710134 DOI: 10.1016/j.gene.2012.06.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 05/29/2012] [Accepted: 06/07/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fabry disease is one of three X-linked lysosomal disorders. Because of X-chromosome inactivation (XCI), wherein there is (random) transcriptional silencing of one of the X-chromosomes in each female cell, females are mosaic for the expression of (some) X-linked genes. Thus, based on penetrance and expression, some females heterozygous for Fabry disease are symptomatic but not to the same degree as hemizygous males. The purpose of this study was to ascertain whether skewed X-inactivation favoring the mutant α-galactosidase A allele exists in our cohort of female heterozygotes of Fabry disease. METHOD All patients were evaluated by physical examination and ascribed disease-specific severity sub-scores for each of the four categories (cardiac, renal, neurological, general) and a total score using the Mainz Severity Score Index (MSSI). Blood samples were drawn for enzymatic activity of α-galactosidase A and for DNA extraction for analysis for α-galactosidase A mutations. XCI ratios were determined from peripheral blood leukocyte samples. The X-chromosome inactivation ratio was determined in each heterozygote. RESULTS Of 77 samples, only 18.2% were highly skewed (80/20). Only 14.3% of samples with nonsense mutations were highly skewed. There were no correlations between the XCI ratios and age, enzymatic activity of α-galactosidase A, MSSI sub-scores or total score, or with the clinical signs of cardiac involvement, neuropathic pain, or proteinuria. CONCLUSION These findings are comparable with others in Fabry disease, i.e., essentially the same as seen in normal non-elderly female population, raising the question of the mechanism underlying symptomatic phenotypic expression in heterozygous females with Fabry disease.
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High-throughput screening identified disease-causing mutants and functional variants of α-galactosidase A gene in Japanese male hemodialysis patients. J Hum Genet 2012; 57:575-9. [PMID: 22695894 DOI: 10.1038/jhg.2012.68] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fabry disease is a genetic disorder caused by deficient activity of lysosomal enzyme α-galactosidase A (GLA) and end-stage renal disease (ESRD) will be present after accumulation of glycosphingolipids within the kidney. Undiagnosed atypical variants of Fabry disease, which are limited to renal involvement, were found in several ESRD patient populations. On the other hand, unexpectedly high frequencies of male subjects having the c.196G>C nucleotide change (p.E66Q) showing low α-GLA activity have been reported on Japanese and Korean screening for Fabry disease. However, several evidences indicate the c.196G>C is not a pathogenic mutation but is a functional polymorphism. In the present study, high-throughput screening of serum GLA could successfully indentify two Fabry disease patients in a cohort consisted of 1080 male hemodialysis patients. Moreover, our serum assay was able to distinguish two patients with disease-causing genetic mutations (p.G195V and p.M296I) from eight functional variants that showed relatively decreased enzyme activity (p.E66Q). In conclusion, high-throughput serum enzyme assay distinctly identified disease-causing mutants and functional variants of GLA gene in Japanese male hemodialysis patients. In addition, our results underscore the high prevalence of not only undiagnosed Fabry patients but functional variants of p.E66Q among the ESRD population.
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