1
|
San Millán-Tejado B, Navarro C, Fernández-Martín J, Rivera A, Viéitez I, Teijeira S, Ortolano S. Morphological Hallmarks of Classical Fabry Disease: An Ultrastructural Study in a Large Spanish Family. J Clin Med 2023; 12:5689. [PMID: 37685755 PMCID: PMC10488914 DOI: 10.3390/jcm12175689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Fabry disease (FD) is a rare lysosomal disorder caused by α-galactosidase A deficiency, and it leads to the systemic deposition of globotriasylceramide. Demonstrations of the storage material in biopsies support this diagnosis. We report a histological and ultrastructural study of biopsies that were performed on 11 individuals from a family with the variant p.Gln279Arg in GLA, which is associated with the classical phenotype of Fabry disease. Intralysosomal deposits were found in all biopsies, corresponding to the skin, kidney, and endomyocardium in both sexes and at different ages. In nine of the skin biopsies, deposits were analysed by immunofluorescence and quantified at the ultrastructural level. Then, the findings were compared according to sex, genotype, and treatment. The quantification of the deposits in the skin biopsies revealed a broader involvement in men than in women. A significant clearance of the deposits was observed in one case after treatment. Tissue involvement was remarkable at diagnosis in all individuals. The findings from the skin biopsies were demonstrative of classic FD, thus supporting the diagnosis; repeated biopsy analyses suggested the benefit of early treatment.
Collapse
Affiliation(s)
- Beatriz San Millán-Tejado
- Rare Disease and Pediatric Medicine Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saúde-Universidade de Vigo (SERGAS-UVIGO), 36312 Vigo, Spain; (J.F.-M.); (I.V.); (S.T.)
- Department of Pathology, Hospital Alvaro Cunqueiro, Servizo Galego de Saúde (SERGAS), 36213 Vigo, Spain;
- Molecular Medicine PhD Program, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Carmen Navarro
- Department of Pathology, Hospital Alvaro Cunqueiro, Servizo Galego de Saúde (SERGAS), 36213 Vigo, Spain;
| | - Julián Fernández-Martín
- Rare Disease and Pediatric Medicine Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saúde-Universidade de Vigo (SERGAS-UVIGO), 36312 Vigo, Spain; (J.F.-M.); (I.V.); (S.T.)
- Department of Internal Medicine, Hospital Alvaro Cunqueiro, Servizo Galego de Saúde (SERGAS), 36213 Vigo, Spain;
| | - Alberto Rivera
- Department of Internal Medicine, Hospital Alvaro Cunqueiro, Servizo Galego de Saúde (SERGAS), 36213 Vigo, Spain;
- Systemic Autoimmune Disease and Thrombose Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saúde-Universidade de Vigo (SERGAS-UVIGO), 36312 Vigo, Spain
| | - Irene Viéitez
- Rare Disease and Pediatric Medicine Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saúde-Universidade de Vigo (SERGAS-UVIGO), 36312 Vigo, Spain; (J.F.-M.); (I.V.); (S.T.)
| | - Susana Teijeira
- Rare Disease and Pediatric Medicine Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saúde-Universidade de Vigo (SERGAS-UVIGO), 36312 Vigo, Spain; (J.F.-M.); (I.V.); (S.T.)
| | - Saida Ortolano
- Rare Disease and Pediatric Medicine Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saúde-Universidade de Vigo (SERGAS-UVIGO), 36312 Vigo, Spain; (J.F.-M.); (I.V.); (S.T.)
| |
Collapse
|
2
|
Goodspeed K, Feng C, Laine M, Lund TC. Aspartylglucosaminuria: Clinical Presentation and Potential Therapies. J Child Neurol 2021; 36:403-414. [PMID: 33439067 DOI: 10.1177/0883073820980904] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Aspartylglucosaminuria (AGU) is a recessively inherited neurodegenerative lysosomal storage disease characterized by progressive intellectual disability, skeletal abnormalities, connective tissue overgrowth, gait disturbance, and seizures followed by premature death. AGU is caused by pathogenic variants in the aspartylglucosaminidase (AGA) gene, leading to glycoasparagine accumulation and cellular dysfunction. Although more prevalent in the Finnish population, more than 30 AGA variants have been identified worldwide. Owing to its rarity, AGU may be largely underdiagnosed. Recognition of the following early clinical features may aid in AGU diagnosis: developmental delays, hyperactivity, early growth spurt, inguinal and abdominal hernias, clumsiness, characteristic facial features, recurring upper respiratory and ear infections, tonsillectomy, multiple sets of tympanostomy tube placement, and sleep problems. Although no curative therapies currently exist, early diagnosis may provide benefit through the provision of anticipatory guidance, management of expectations, early interventions, and prophylaxis; it will also be crucial for increased clinical benefits of future AGU disease-modifying therapies.
Collapse
Affiliation(s)
- Kimberly Goodspeed
- 7067University of Texas Southwestern Medical Center, Department of Pediatrics, Dallas, TX, USA
| | | | - Minna Laine
- Division of Child Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Troy C Lund
- 5635University of Minnesota, Department of Pediatrics, Minneapolis, MN, USA
| |
Collapse
|
3
|
Luna PC, Boggio P, Larralde M. Dermatologic Aspects of Fabry Disease. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2016. [DOI: 10.1177/2326409816661353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Paula C. Luna
- Dermatology Department, Hospital Alemán, Buenos Aires, Argentina
- Dermatology Department, Hospital General de Agudos J. M. Ramos Mejia, Buenos Aires, Argentina
| | - Paula Boggio
- Dermatology Department, Hospital General de Agudos J. M. Ramos Mejia, Buenos Aires, Argentina
| | - Margarita Larralde
- Dermatology Department, Hospital Alemán, Buenos Aires, Argentina
- Dermatology Department, Hospital General de Agudos J. M. Ramos Mejia, Buenos Aires, Argentina
| |
Collapse
|
4
|
Opladen T, Ebinger F, Zschocke J, Sengupta D, Ben-Omran T, Shahbeck N, Moog U, Fischer C, Bürger F, Haas D, Ruef P, Harting I, Al-Rifai H, Hoffmann GF. Aspartylglucosaminuria: unusual neonatal presentation in Qatari twins with a novel aspartylglucosaminidase gene mutation and 3 new cases in a Turkish family. J Child Neurol 2014; 29:36-42. [PMID: 23271757 DOI: 10.1177/0883073812469049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aspartylglucosaminuria is a rare autosomal recessive lysosomal storage disorder leading early to a progressive intellectual disability. Monozygous Qatari twins presented with an unusual perinatal manifestation characterized by severe muscular hypotonia, scarce spontaneous movements, multiple contractures, and respiratory insufficiency. Biochemical investigations suggested aspartylglucosaminuria, and a novel homozygous mutation c.439T>C (p.S147P) was found in the aspartylglucosaminidase gene. However, it cannot be excluded that the unusual neonatal presentation is due to an additional autosomal recessive disease in this multiply consanguineous family. The classical aspartylglucosaminuria phenotype (progressive speech delay, psychomotor retardation, and behavioral abnormalities) was observed in 3 Turkish siblings. Although aspartylglucosaminuria was suspected early, the definite diagnosis was not confirmed until the age of 18 years. A novel homozygous mutation c.346C>T (p.R116W) was found. These 5 cases emphasize that aspartylglucosaminuria is panethnic and may possibly present with prenatal manifestation. Screening for aspartylglucosaminuria should be done in all patients with unexplained psychomotor retardation.
Collapse
Affiliation(s)
- Thomas Opladen
- 1Department of Pediatrics, Division of Inborn Metabolic Diseases, University Children's Hospital, Heidelberg, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Han F, Wang P, Li Z, Zheng J, Wang Q, Xu A, Wang Z. Angiokeratoma corporis diffusum in a patient with Hodgkin lymphoma: a new paraneoplastic skin manifestation? Br J Dermatol 2013; 168:1351-3. [DOI: 10.1111/bjd.12188] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
6
|
Guinovart R, Bielsa I, Pintos-Morell G, Ferrándiz C. Fabry Disease and the Clinical Spectrum of Angiokeratomas. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.adengl.2013.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
7
|
Guinovart R, Bielsa I, Pintos-Morell G, Ferrándiz C. Enfermedad de Fabry: espectro clínico de los angioqueratomas. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:261-3. [DOI: 10.1016/j.ad.2012.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 03/17/2012] [Accepted: 03/21/2012] [Indexed: 11/25/2022] Open
|
8
|
Zampetti A, Orteu C, Antuzzi D, Bongiorno M, Manco S, Gnarra M, Morrone A, Cardinali G, Kovacs D, Aspite N, Linder D, Parini R, Feliciani C. Angiokeratoma: decision-making aid for the diagnosis of Fabry disease. Br J Dermatol 2012; 166:712-20. [DOI: 10.1111/j.1365-2133.2012.10742.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
9
|
Staretz-Chacham O, Choi JH, Wakabayashi K, Lopez G, Sidransky E. Psychiatric and behavioral manifestations of lysosomal storage disorders. Am J Med Genet B Neuropsychiatr Genet 2010; 153B:1253-65. [PMID: 20872765 DOI: 10.1002/ajmg.b.31097] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The different lysosomal storage disorders (LSDs) manifest with a wide spectrum of clinical presentations. Most of these disorders are typically diagnosed early in life, due to the severity of the associated phenotypes. However, it is important to appreciate that some of the LSDs present later in adolescence or adulthood. The diverse findings triggering the initial diagnosis, as well as the range of manifestations arising later during the disease course, contribute to the complexity of these issues. Clinical presentations occurring at a more advanced age, especially psychiatric and behavioral manifestations, can be overlooked or misdiagnosed. This review describes different psychiatric and behavioral manifestations encountered in individuals with LSDs, including psychosis, schizophrenia, mood disorders, aggressiveness, early-onset dementia, and conduct disorder. Twelve different disorders are presented, including descriptions of their associated biochemical abnormalities, clinical presentations, pathology, epidemiology, and genetics. In addition, discussions of neurocognitive, behavioral, and psychiatric findings are outlined for each disorder. A greater awareness of these features may help to reduce missed diagnoses, to avoid unnecessary, invasive and expensive testing, and to facilitate an earlier detection of these rare disorders. Earlier diagnosis can enable the implementation of appropriate interventions and improve genetic counseling.
Collapse
Affiliation(s)
- Orna Staretz-Chacham
- Office of the Clinical Director, National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
| | | | | | | | | |
Collapse
|