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Breyer M, Grüner J, Klein A, Finke L, Klug K, Sauer M, Üçeyler N. In vitro characterization of cells derived from a patient with the GLA variant c.376A>G (p.S126G) highlights a non-pathogenic role in Fabry disease. Mol Genet Metab Rep 2024; 38:101029. [PMID: 38469097 PMCID: PMC10926200 DOI: 10.1016/j.ymgmr.2023.101029] [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: 11/05/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 03/13/2024] Open
Abstract
Fabry disease (FD) is a life-limiting disorder characterized by intracellular globotriaosylceramide (Gb3) accumulations. The underlying α-galactosidase A (α-GAL A) deficiency is caused by variants in the gene GLA. Variants of unknown significance (VUS) are frequently found in GLA and challenge clinical management. Here, we investigated a 49-year old man with cryptogenic lacunar cerebral stroke and the chance finding of the VUS S126G, who was sent to our center for diagnosis and initiation of a costly and life-long FD-specific treatment. We combined clinical examination with in vitro investigations of dermal fibroblasts (HDF), induced pluripotent stem cells (iPSC), and iPSC-derived sensory neurons. We analyzed α-GAL A activity in iPSC, Gb3 accumulation in all three cell types, and action potential firing in sensory neurons. Neurological examination and small nerve fiber assessment was normal except for reduced distal skin innervation. S126G iPSC showed normal α-GAL A activity compared to controls and no Gb3 deposits were found in all three cell types. Baseline electrophysiological characteristics of S126G neurons showed no difference compared to healthy controls as investigated by patch-clamp recordings. We pioneer multi-level cellular characterization of the VUS S126G using three cell types derived from a patient and provide further evidence for the benign nature of S126G in GLA, which is of great importance in the management of such cases in clinical practice.
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Affiliation(s)
- Maximilian Breyer
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany
| | - Julia Grüner
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany
| | - Alexandra Klein
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany
| | - Laura Finke
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany
| | - Katharina Klug
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany
| | - Markus Sauer
- Department of Biophysics and Biotechnology, Biocenter, University of Würzburg, 97074 Würzburg, Germany
| | - Nurcan Üçeyler
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany
- Würzburg Fabry Center for Interdisciplinary Therapy (FAZIT), University of Würzburg, 97080 Würzburg, Germany
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Rekova P, Kovarova I, Uher T, Srpova B, Dostalova G, Linhart A, Vaneckova M, Stastna D. Missed diagnosis of Fabry disease: should we screen patients with multiple sclerosis? Neurol Sci 2024; 45:231-239. [PMID: 37480392 PMCID: PMC10761551 DOI: 10.1007/s10072-023-06962-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/11/2023] [Indexed: 07/24/2023]
Abstract
INTRODUCTION Fabry disease (FD) can be undiagnosed in the context of multiple sclerosis (MS) due to similar clinical and paraclinical features. Our study aimed to determine the prevalence (and the necessity of screening) of FD among patients with possible or definite MS. METHODS In this prospective monocentric observational study, we included consecutive patients enrolled between May 2017 and May 2019 after the first clinical event suggestive of MS. All patients underwent FD screening using dried blood spots in a stepwise manner combining genetic and enzyme testing. Patients were followed until May 2022. RESULTS We included 160 patients (73.1% female, mean age 33.9 years). The 2017 revised McDonald's criteria for definite MS were fulfilled by 74 (46.3%) patients at the time of study recruitment and 89 (55.6%) patients after 3-5 years of follow-up. None of the patients had a pathogenic GLA variant, and four (2.5%) had a variant of unknown significance (p.A143T, p.S126G, 2 × p.D313Y). In two of these patients, the intrathecal synthesis of oligoclonal bands was absent, and none had hyperproteinorachia or pleocytosis in cerebrospinal fluid. Detailed examination of FD organ manifestations revealed only discrete ocular and kidney involvement in two patients. CONCLUSION The prevalence of FD in the population of suspected or definite MS patients does not appear to be high. Our results do not support routine FD screening in all patients with a possible diagnosis of MS, but there is an urgent need to search for red flags and include FD in the differential diagnosis of MS.
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Affiliation(s)
- Petra Rekova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Ivana Kovarova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Tomas Uher
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Barbora Srpova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Gabriela Dostalova
- Second Department of Internal Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Ales Linhart
- Second Department of Internal Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Dominika Stastna
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia.
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Ahmed H, Backer V, Effraimidis G, Rasmussen ÅK, Kistorp CM, Feldt-Rasmussen U. Respiratory impairments in patients suffering from Fabry disease - A cross-sectional study. Chron Respir Dis 2024; 21:14799731231221821. [PMID: 38334083 PMCID: PMC10858660 DOI: 10.1177/14799731231221821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/01/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND The inherited X-linked disorder, Fabry disease, is caused by deficient lysosomal enzyme α-galactosidase A, with progressive accumulation of globotriaosylceramide in multiple organs including the upper and lower airways. OBJECTIVES To assess pulmonary function at the time of the first pulmonary function test (PFT) performed among the National Danish Fabry cohort and define the prevalence of affected lung function variables. MATERIALS AND METHOD A cross-sectional retrospective cohort study of 86 adult patients enrolled in one or both international patient registry databases for Fabry disease, Fabry Registry or FollowME with at least one PFT. The Mainz Severity Score Index (MSSI) was calculated to determine the disease severity. Lung function variables were examined by multivariate regression adjusted for important variables for developing airway illness. RESULTS Seventeen patients (20%) showed obstructive airflow limitation and 7 (8%) a restrictive lung deficiency. Smoking status (p = .016) and MSSI (p < .001) were associated with increasing obstructive airway limitation. CONCLUSION The prevalence of affected lung function among the National Danish Fabry cohort was 28%. Patients with classic gene variants frequently developed a decrease in lung function regardless of their smoking status, with significant relationship with disease severity.
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Affiliation(s)
- Huma Ahmed
- Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Vibeke Backer
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Otorhinolaryngology, Head and Neck and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Grigoris Effraimidis
- Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Endocrinology and Metabolic Diseases, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Åse Krogh Rasmussen
- Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Caroline Michaela Kistorp
- Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Bei E, Antonopoulos AS, Tsivgoulis G, Vlachopoulos C. Fabry disease due to D313Y variant with renal failure and possible cardiac involvement: a case report. Eur Heart J Case Rep 2023; 7:ytad224. [PMID: 37201153 PMCID: PMC10187784 DOI: 10.1093/ehjcr/ytad224] [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: 09/20/2022] [Revised: 11/17/2022] [Accepted: 04/26/2023] [Indexed: 05/20/2023]
Abstract
Background This is a case report of a patient with Anderson-Fabry disease (AFD) due to the D313Y variant on the a-galactosidase A (GLA) gene on migalastat treatment and severe chronic kidney disease referred to our unit to assess possible cardiac involvement. Case summary A 53-year-old man with chronic kidney disease due to AFD and a medical history of revascularized coronary artery disease, chronic atrial fibrillation, and arterial hypertension was referred to our unit for evaluation of possible cardiac involvement in the context of AFD. Biochemical evaluation reported reduced serum alpha-galactosidase A activity and borderline abnormal serum lyso-Gb3 enzyme activity. The patient had also history of acroparesthesias, dermatological presentation of multiple angiokeratomas, severe kidney impairment with an estimated glomerular filtration rate (eGFR) of 30 mL/min/1.73m² by the age of 16, and microalbuminuria that cumulatively set the diagnosis of AFD. Transthoracic echocardiogram showed left ventricular concentric hypertrophy with left ventricular ejection fraction of 45%. Cardiac magnetic resonance showed findings in keeping with ischaemic heart disease (IHD), i.e. akinesia and subendocardial scarring of the basal anterior and the entirety of the septum and the true apex; in addition, there was severe asymmetrical hypertrophy of the basal anteroseptum (max 18 mm), evidence of low-grade myocardial inflammation, and mid-wall fibrosis of the basal inferior and inferolateral wall, suggesting a cardiomyopathic process-myocardial disease which could not be explained solely by IHD or well-controlled hypertension. Discussion This is the first case of possible cardiac involvement in a patient with AFD due to the D313Y variant. This case demonstrates the diagnostic challenges of cardiac involvement in AFD, especially in the presence of a concomitant underlying pathology.
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Affiliation(s)
| | - Alexios S Antonopoulos
- Unit of Inherited Cardiac and Rare Diseases, First Department of Cardiology, National and Kapodistrian University of Athens, 114 Vas. Sofias Avenue, 11527 Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon General Hospital, National and Kapodistrian University of Athens, 1 Rimini st, 12462 Haidari, Greece
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Strunk D, Becker J, Veltkamp R, Meuth SG, Bauer P, Böttcher T, Rolfs A, Schwitalla JC, Kraemer M. How relevant are cerebral white matter lesions in the D313Y variant of the α-galactosidase A gene? Neurological, cardiological, laboratory, and MRI data of 21 patients within a follow-up of 3 years. Neurol Sci 2023; 44:1375-1381. [PMID: 36456878 DOI: 10.1007/s10072-022-06533-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/24/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Fabry disease is an inherited metabolic disorder with various symptoms. Neurological manifestations are small fiber neuropathy, cerebral white matter lesions (WML), megadolicho basilar artery, and stroke. The relevance of the D313Y variant in the galactosidase alpha gene is controversially discussed. OBJECTIVES We aimed at elucidating the implications of this differential diagnosis of multiple sclerosis (MS), focussing on the analysis of WML over time and correlations with other markers. METHODS We reviewed retrospectively the clinical, laboratory, and magnetic resonance imaging data of 21 carriers of the D313Y variant at a single German outpatient clinic for MS between 2004 and 2021. RESULTS In our cohort (15 females, 6 males), mean age at diagnosis was 44.1 ± 16.3 years, and mean follow-up duration was 3.1 ± 3.9 years. WML were rated on both, the Fazekas scale and the age-related white matter changes rating scale, and were of variable interindividual extent. Follow-up imaging showed virtually no progress. WML did not correlate with the severity of clinical findings or lysoGb3 levels. Symptomatic carriers of the variant are characterized by an almost complete lack of internal organ manifestations and laboratory findings, usually associated with Fabry disease. CONCLUSION WML in carriers of the D313Y variant do not seem to be suitable for assessing or predicting the (para-) clinical status. Concerning MS patients, the variant and its clinical signs can be a differential diagnosis, but also a co-factor. Imaging and cerebrospinal fluid findings facilitate the distinction between both entities.
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Affiliation(s)
- Daniel Strunk
- Department of Neurology, Alfried Krupp Krankenhaus Essen, Alfried-Krupp-Straße 21, 45131, Essen, Germany.
| | - Jana Becker
- Department of Neurology, Alfried Krupp Krankenhaus Essen, Alfried-Krupp-Straße 21, 45131, Essen, Germany
| | - Roland Veltkamp
- Department of Neurology, Alfried Krupp Krankenhaus Essen, Alfried-Krupp-Straße 21, 45131, Essen, Germany
- Department of Brain Sciences, Imperial College London, London, UK
| | - Sven G Meuth
- Department of Neurology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Tobias Böttcher
- CENTOGENE GmbH, Rostock, Germany
- Medical Service Center of Johanna-Odebrecht-Stiftung, Greifswald, Germany
| | - Arndt Rolfs
- Arcenus Diagnostics, Hoboken, NJ, 07030, USA
| | | | - Markus Kraemer
- Department of Neurology, Alfried Krupp Krankenhaus Essen, Alfried-Krupp-Straße 21, 45131, Essen, Germany
- Department of Neurology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Screening of Fabry disease in patients with an implanted permanent pacemaker. Int J Cardiol 2023; 372:71-75. [PMID: 36473604 DOI: 10.1016/j.ijcard.2022.11.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/14/2022] [Accepted: 11/29/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Anderson-Fabry disease (AFD) is an X-linked inherited lysosomal disease caused by a defect in the gene encoding lysosomal enzyme α-galactosidase A (GLA). Atrio-ventricular (AV) nodal conduction defects and sinus node dysfunction are common complications of the disease. It is not fully elucidated how frequently AFD is responsible for acquired AV block or sinus node dysfunction and if some AFD patients could manifest primarily with spontaneous bradycardia in general population. The purpose of study was to evaluate the prevalence of AFD in male patients with implanted permanent pacemaker (PM). METHODS The prospective multicentric screening in consecutive male patients between 35 and 65 years with implanted PM for acquired third- or second- degree type 2 AV block or symptomatic second- degree type 1 AV block or sinus node dysfunction was performed. RESULTS A total of 484 patients (mean age 54 ± 12 years at time of PM implantation) were enrolled to the screening in 12 local sites in Czech Republic. Out of all patients, negative result was found in 481 (99%) subjects. In 3 cases, a GLA variant was found, classified as benign: p.Asp313Tyr, p.D313Y). Pathogenic GLA variants (classical or non-classical form) or variants of unclear significance were not detected. CONCLUSION The prevalence of pathogenic variants causing AFD in a general population sample with implanted permanent PM for AV conduction defects or sinus node dysfunction seems to be low. Our findings do not advocate a routine screening for AFD in all adult males with clinically significant bradycardia.
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Lackova A, Beetz C, Oppermann S, Bauer P, Pavelekova P, Lorincova T, Ostrozovicova M, Kulcsarova K, Cobejova J, Cobej M, Levicka P, Liesenerova S, Sendekova D, Sukovska V, Gdovinova Z, Han V, Rizig M, Houlden H, Skorvanek M. Prevalence of Fabry Disease among Patients with Parkinson's Disease. PARKINSON'S DISEASE 2022; 2022:1014950. [PMID: 35111290 PMCID: PMC8803460 DOI: 10.1155/2022/1014950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/08/2022] [Accepted: 01/11/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND An increased prevalence of Parkinson's disease (PD) disease has been previously reported in subjects with Fabry disease (FD) carrying alpha-galactosidase (GLA) mutations and their first-line relatives. Moreover, decreased alpha-galactosidase A (AGLA) enzymatic activity has been reported among cases with PD compared to controls. OBJECTIVE The aim of our study was to determine the prevalence of FD among patients with PD. METHODS We recruited 236 consecutive patients with PD from February 2018 to December 2020. Clinical and sociodemographic data, including the MDS-UPDRS-III scores and HY stage (the Hoehn and Yahr scale), were collected, and in-depth phenotyping was performed in subjects with identified GLA variants. A multistep approach, including standard determination of AGLA activity and LysoGb3 in males, and next-generation based GLA sequencing in all females and males with abnormal AGLA levels was performed in a routine diagnostic setting. RESULTS The mean age of our patients was 68.9 ± 8.9 years, 130 were men (55.1%), and the mean disease duration was 7.77 ± 5.35 years. Among 130 men, AGLA levels were low in 20 patients (15%), and subsequent Lyso-Gb3 testing showed values within the reference range for all tested subjects. In 126 subsequently genetically tested patients, four heterozygous p.(Asp313Tyr) GLA variants (3.2%, MAF 0.016) were identified; all were females. None of the 4 GLA variant carriers identified had any clinical manifestation suggestive of FD. CONCLUSIONS The results of this study suggest a possible relationship between FD and PD in a small proportion of cases. Nevertheless, the GLA variant found in our cohort is classified as a variant of unknown significance. Therefore, its pathogenic causative role in the context of PD needs further elucidation, and these findings should be interpreted with caution.
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Affiliation(s)
- Alexandra Lackova
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
- Department of Neurology, University Hospital of L. Pasteur, Košice, Slovakia
| | | | | | | | - Petra Pavelekova
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
- Department of Neurology, University Hospital of L. Pasteur, Košice, Slovakia
| | - Tatiana Lorincova
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
| | - Miriam Ostrozovicova
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
- Department of Neurology, University Hospital of L. Pasteur, Košice, Slovakia
| | - Kristina Kulcsarova
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
- Department of Neurology, University Hospital of L. Pasteur, Košice, Slovakia
| | - Jana Cobejova
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
| | - Martin Cobej
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
| | - Petra Levicka
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
| | - Simona Liesenerova
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
| | - Daniela Sendekova
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
| | - Viktoria Sukovska
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
| | - Zuzana Gdovinova
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
- Department of Neurology, University Hospital of L. Pasteur, Košice, Slovakia
| | - Vladimir Han
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
- Department of Neurology, University Hospital of L. Pasteur, Košice, Slovakia
| | - Mie Rizig
- University College London, Institute of Neurology, Department of Neuromuscular Disorders, Queen Square, WC1N 3BG London, UK
| | - Henry Houlden
- University College London, Institute of Neurology, Department of Neuromuscular Disorders, Queen Square, WC1N 3BG London, UK
| | - Matej Skorvanek
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
- Department of Neurology, University Hospital of L. Pasteur, Košice, Slovakia
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Reková P, Dostálová G, Kemlink D, Paulasová Schwabová J, Dubská Z, Vaneckova M, Mašek M, Kodet O, Poupětová H, Mazurová S, Rajdova A, Vlckova E, Táboříková A, Fafejtová Š, Nevsimalova M, Linhart A, Tomek A. Detailed Phenotype of GLA Variants Identified by the Nationwide Neurological Screening of Stroke Patients in the Czech Republic. J Clin Med 2021; 10:jcm10163543. [PMID: 34441839 PMCID: PMC8396867 DOI: 10.3390/jcm10163543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 11/17/2022] Open
Abstract
Fabry disease (FD) is a rare X-linked disorder of glycosphingolipid metabolism caused by pathogenic variants within the alpha-galactosidase A (GLA) gene, often leading to neurological manifestations including stroke. Multiple screening programs seeking GLA variants among stroke survivors lacked detailed phenotype description, making the interpretation of the detected variant’s pathogenicity difficult. Here, we describe detailed clinical characteristics of GLA variant carriers identified by a nationwide stroke screening program in the Czech Republic. A total of 23 individuals with 8 different GLA variants were included in the study. A comprehensive diagnostic workup was performed by a team of FD specialists. The investigation led to the suggestion of phenotype reclassification for the G325S mutation from late-onset to classical. A novel variant R30K was found and was classified as a variant of unknown significance (VUS). The typical manifestation in our FD patients was a stroke occurring in the posterior circulation with an accompanying pathological finding in the cerebrospinal fluid. Moreover, we confirmed that cornea verticillata is typically associated with classical variants. Our findings underline the importance of detailed phenotype description and data sharing in the correct identification of pathogenicity of gene variants detected by high-risk-population screening programs.
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Affiliation(s)
- Petra Reková
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic;
| | - Gabriela Dostálová
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University, 128 08 Prague, Czech Republic; (G.D.); (A.L.)
| | - David Kemlink
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic;
- Correspondence: ; Tel.: +420-22-496-5512
| | - Jaroslava Paulasová Schwabová
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital in Prague, 150 06 Prague, Czech Republic; (J.P.S.); (A.T.)
- Department of Paediatric Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital in Prague, 150 06 Prague, Czech Republic
| | - Zora Dubská
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic;
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic; (M.V.); (M.M.)
| | - Martin Mašek
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic; (M.V.); (M.M.)
| | - Ondřej Kodet
- Department of Dermatovenerology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic;
- Biotechnology and Biomedicine Centre, Academy of Science, Charles University, 252 50 Vestec, Czech Republic
- Institute of Anatomy First Faculty of Medicine, Charles University in Prague, 128 08 Prague, Czech Republic
| | - Helena Poupětová
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, University and General University Hospital in Prague, 128 08 Prague, Czech Republic; (H.P.); (S.M.)
| | - Stella Mazurová
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, University and General University Hospital in Prague, 128 08 Prague, Czech Republic; (H.P.); (S.M.)
| | - Aneta Rajdova
- Department of Neurology, Faculty of Medicine, Masaryk University and University Hospital Brno, 625 00 Brno, Czech Republic; (A.R.); (E.V.)
| | - Eva Vlckova
- Department of Neurology, Faculty of Medicine, Masaryk University and University Hospital Brno, 625 00 Brno, Czech Republic; (A.R.); (E.V.)
| | - Alena Táboříková
- Department of Neurology and Stroke Centre, Country Hospital Chomutov, 430 12 Chomutov, Czech Republic;
| | - Štěpánka Fafejtová
- Department of Neurology and Stroke Centre, Hospital Karlovy Vary, 360 01 Karlovy Vary, Czech Republic;
| | - Miroslava Nevsimalova
- Department of Neurology, Hospital Ceske Budejovice, 370 01 České Budějovice, Czech Republic;
| | - Aleš Linhart
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University, 128 08 Prague, Czech Republic; (G.D.); (A.L.)
| | - Aleš Tomek
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital in Prague, 150 06 Prague, Czech Republic; (J.P.S.); (A.T.)
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von Cossel K, Muschol N, Friedrich RE, Glatzel M, Ammer L, Lohmöller B, Bendszus M, Mautner VF, Godel T. Assessment of small fiber neuropathy in patients carrying the non-classical Fabry variant p.D313Y. Muscle Nerve 2021; 63:745-750. [PMID: 33543778 DOI: 10.1002/mus.27196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The pathophysiological significance of the Fabry-related, non-classical variant p.D313Y still remains to be solved. This study assesses the involvement of the peripheral nervous system with respect to small fiber neuropathy and neuropathic pain in female patients carrying p.D313Y. METHODS This study examined nine females carrying the Fabry-related p.D313Y variant by obtaining skin punch biopsies above the right lateral malleolus. Intraepidermal nerve fiber density was determined for each patient and compared to reference values matched for the patient's decade of life and sex. Moreover, each patient was characterized by a detailed neurological examination and by pain assessment via questionnaire. RESULTS Compared to sex-matched lower fifth percentile reference values per decade, intraepidermal nerve fiber density was decreased in seven out of nine patients. Four patients reported acral paresthesias and neuropathic pain with an average visual analogue scale score of 7 out of 10 points. Two patients experienced acute pain crises. Six out of seven patients diagnosed with small fiber neuropathy had a their medical history of hypo- and/or hyperhidrosis. DISCUSSION The diagnosis of small fiber neuropathy was made in seven out of nine females carrying the non-classical variant p.D313Y. Moreover, neuropathic pain and symptoms indicative of autonomic nervous system dysfunction seem to be common findings that may be of clinical significance and may warrant therapeutic intervention.
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Affiliation(s)
- Katharina von Cossel
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicole Muschol
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Reinhard E Friedrich
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Glatzel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Luise Ammer
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Lohmöller
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Heidelberg, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Godel
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Heidelberg, Germany
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10
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Rickert V, Wagenhäuser L, Nordbeck P, Wanner C, Sommer C, Rost S, Üçeyler N. Stratification of Fabry mutations in clinical practice: a closer look at α-galactosidase A-3D structure. J Intern Med 2020; 288:593-604. [PMID: 32583479 DOI: 10.1111/joim.13125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/25/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Fabry disease (FD) is an X-linked lysosomal storage and multi-system disorder due to mutations in the α-galactosidase A (α-GalA) gene. We investigated the impact of individual amino acid exchanges in the α-GalA 3D-structure on the clinical phenotype of FD patients. PATIENTS AND METHODS We enrolled 80 adult FD patients with α-GalA missense mutations and stratified them into three groups based on the amino acid exchange location in the α-GalA 3D-structure: patients with active site mutations, buried mutations and other mutations. Patient subgroups were deep phenotyped for clinical and laboratory parameters and FD-specific treatment. RESULTS Patients with active site or buried mutations showed a severe phenotype with multi-organ involvement and early disease manifestation. Patients with other mutations had a milder phenotype with less organ impairment and later disease onset. α-GalA activity was lower in patients with active site or buried mutations than in those with other mutations (P < 0.01 in men; P < 0.05 in women) whilst lyso-Gb3 levels were higher (P < 0.01 in men; <0.05 in women). CONCLUSIONS The type of amino acid exchange location in the α-GalA 3D-structure determines disease severity and temporal course of symptom onset. Patient stratification using this parameter may become a useful tool in the management of FD patients.
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Affiliation(s)
- V Rickert
- From the, Department of Neurology, University of Würzburg, Würzburg, Germany
| | - L Wagenhäuser
- From the, Department of Neurology, University of Würzburg, Würzburg, Germany
| | - P Nordbeck
- Fabry Centre for Interdisciplinary Therapy Würzburg (FAZIT), University of Würzburg, Würzburg, Germany.,Department of Internal Medicine, Division of Cardiology, University of Würzburg, Würzburg, Germany
| | - C Wanner
- Fabry Centre for Interdisciplinary Therapy Würzburg (FAZIT), University of Würzburg, Würzburg, Germany.,Department of Internal Medicine, Division of Nephrology, University of Würzburg, Würzburg, Germany
| | - C Sommer
- From the, Department of Neurology, University of Würzburg, Würzburg, Germany.,Fabry Centre for Interdisciplinary Therapy Würzburg (FAZIT), University of Würzburg, Würzburg, Germany
| | - S Rost
- Institute of Human Genetics, University of Würzburg, Würzburg, Germany
| | - N Üçeyler
- From the, Department of Neurology, University of Würzburg, Würzburg, Germany.,Fabry Centre for Interdisciplinary Therapy Würzburg (FAZIT), University of Würzburg, Würzburg, Germany
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11
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Effraimidis G, Rasmussen ÅK, Bundgaard H, Sørensen SS, Feldt-Rasmussen U. Is the alpha-galactosidase A variant p.Asp313Tyr (p.D313Y) pathogenic for Fabry disease? A systematic review. J Inherit Metab Dis 2020; 43:922-933. [PMID: 32246457 DOI: 10.1002/jimd.12240] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/13/2020] [Accepted: 03/30/2020] [Indexed: 12/21/2022]
Abstract
The identification of pathogenic GLA variants plays a central role in the establishment of a definite Fabry disease (FD) diagnosis. We aimed to review and interpret the published data on the p.Asp313Tyr (p.D313Y) variant pathogenicity and clinical relevance. We performed a systematic review of peer-reviewed publications and case-reports on individuals and populations harbouring the p.Asp313Tyr variant. Overall, 35 studies were included in this review. We collected data regarding the clinical manifestations, alpha-galactosidase A enzyme activity, levels of the biomarkers globotriaosylceramide (Gb3 ) and sphingosine-globotriaosylceramide (lyso-Gb3 ) and histological findings of p.Asp313Tyr carriers. The prevalence of p.Asp313Tyr in populations at risk for FD (kidney, heart, neurologic disorders, or symptomatic populations) was calculated. We found high residual enzyme activity, low frequency of clinical features specific for FD, non-elevated lysoGb3 /Gb3 concentrations and lack of intracellular Gb3 accumulation in biopsies in the p.Asp313Tyr carriers. The prevalence of the variant in populations at risk for FD was comparable to the reported frequency in the general population. A possible higher frequency was only observed in neurologic disorders. p.Asp313Tyr can be classified as neutral or variant of unknown significance. Further investigations will be helpful to clarify a possible association between the variant and manifestations in the brain vessels.
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Affiliation(s)
- Grigoris Effraimidis
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Åse K Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, The Capital Region's Unit of Inherited Cardiac Diseases, Faculty of Health and Medical Sciences, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Søren S Sørensen
- Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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12
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Dong ZY, Wang Q, Lin SP, Chen P, Liu JN, Liu SW, Cai GY, Chen XM, Hong Q. GLA missense and promoter variants co-segregating in a Chinese family with Fabry disease. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:865. [PMID: 32793709 DOI: 10.21037/atm-19-4510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Fabry disease (FD) is an X-linked recessive inheritance lysosomal storage disorder due to mutations in the GLA gene leading to deficiency of lysosomal α-galactosidase A (α-Gal A) and has a wide range of clinical presentations. Over 900 GLA gene mutations are currently known and of those most are thought not to be clinically significant, some with doubtful clinical significance, posing diagnostic and prognostic difficulties for the clinician. Methods Whole-exome sequencing (WES) was performed to detect the mutation in family members with Fabry disease. The function of g.1170C>T mutation was confirmed by dual luciferase system. Results A total of 1,375 variants were found in a Chinese family with FD. A missense variants c.1025C>T (p.Arg342Gln) which have been previously reported in association with FD and g.1170C>T single-nucleotide polymorphism (SNP) in the GLA gene were found in five patients. The g.1170C>T SNP affects transcription of GLA gene, presumably the transcription start site. Female patients only have hypohidrosis and neuropathic pain, while male patients have severe symptoms with simultaneous renal impairment. Conclusions Two simultaneous variants in cis of the GLA gene, c.1025C>T (p.Arg342Gln) and g.1170C>T, were verified in Chinese individuals, and the corresponding clinical symptoms were described. The disease severity in male patients is worse than in female patients. These results may be helpful for genetic counseling, diagnosis and prognosis of patients with FD.
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Affiliation(s)
- Zhe-Yi Dong
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Qian Wang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Shu-Peng Lin
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Pu Chen
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Jiao-Na Liu
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Shu-Wen Liu
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Guang-Yan Cai
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Xiang-Mei Chen
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Quan Hong
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
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13
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Varela P, Mastroianni Kirsztajn G, Motta FL, Martin RP, Turaça LT, Ferrer HLF, Gomes CP, Nicolicht P, Mara Marins M, Pessoa JG, Braga MC, D'Almeida V, Martins AM, Pesquero JB. Correlation between GLA variants and alpha-Galactosidase A profile in dried blood spot: an observational study in Brazilian patients. Orphanet J Rare Dis 2020; 15:30. [PMID: 31996269 PMCID: PMC6990533 DOI: 10.1186/s13023-019-1274-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 12/05/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Fabry disease is a rare X-linked inherited disorder caused by deficiency of α-Galactosidase A. Hundreds of mutations and non-coding haplotypes in the GLA gene have been described; however, many are variants of unknown significance, prompting doubts about the diagnosis and treatment. The α-Galactosidase A enzymatic activity in dried blood spot (DBS) samples are widely used for screening purposes; however, even when values below the normal are found, new tests are required to confirm the diagnosis. Here we describe an analysis of GLA variants and their correlation with DBS α-Galactosidase A enzymatic activity in a large Brazilian population with Fabry disease symptoms. RESULTS We analyzed GLA variants by DNA sequencing of 803 male patients with suspected Fabry disease or belonging to high-risk populations; in 179 individuals, 58 different exonic variants were detected. From these, 50 are variants described as pathogenic and eight described as variants of unknown significance. The other individuals presented complex non-coding haplotypes or had no variants. Interestingly, the enzymatic activity in DBS was different among pathogenic variants and the other genotypes, including variants of unknown significance; the first presented mean of 12% of residual activity, while the others presented levels above 70% of the activity found in healthy controls. CONCLUSION The activity of α-Galactosidase A in DBS was markedly reduced in males with known pathogenic variants when compared with subjects presenting variants of unknown significance, non-coding haplotypes, or without variants, indicating a possible non-pathogenic potential of these latter genotypes. These findings bring a better understanding about the biochemical results of α-Galactosidase A in DBS samples, as well as the possible non-pathogenic potential of non-coding haplotypes and variants of unknown significance in GLA gene. These results certainly will help clinicians to decide about the treatment of patients carrying variants in the gene causing this rare but life-threatening disease.
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Affiliation(s)
- Patrícia Varela
- Center for Research and Molecular Diagnostic of Genetic Diseases - Department of Biophysics, Federal University of São Paulo, Rua Pedro de Toledo, 669 - 9o andar, São Paulo, 04039-032, Brazil
| | | | - Fabiana L Motta
- Center for Research and Molecular Diagnostic of Genetic Diseases - Department of Biophysics, Federal University of São Paulo, Rua Pedro de Toledo, 669 - 9o andar, São Paulo, 04039-032, Brazil
| | - Renan P Martin
- Center for Research and Molecular Diagnostic of Genetic Diseases - Department of Biophysics, Federal University of São Paulo, Rua Pedro de Toledo, 669 - 9o andar, São Paulo, 04039-032, Brazil.,McKeusick-Nathans Institute of Genetic Medicine - Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lauro T Turaça
- Center for Research and Molecular Diagnostic of Genetic Diseases - Department of Biophysics, Federal University of São Paulo, Rua Pedro de Toledo, 669 - 9o andar, São Paulo, 04039-032, Brazil
| | - Henrique L F Ferrer
- Center for Research and Molecular Diagnostic of Genetic Diseases - Department of Biophysics, Federal University of São Paulo, Rua Pedro de Toledo, 669 - 9o andar, São Paulo, 04039-032, Brazil
| | - Caio P Gomes
- Center for Research and Molecular Diagnostic of Genetic Diseases - Department of Biophysics, Federal University of São Paulo, Rua Pedro de Toledo, 669 - 9o andar, São Paulo, 04039-032, Brazil
| | - Priscila Nicolicht
- Center for Research and Molecular Diagnostic of Genetic Diseases - Department of Biophysics, Federal University of São Paulo, Rua Pedro de Toledo, 669 - 9o andar, São Paulo, 04039-032, Brazil
| | - Maryana Mara Marins
- Center for Research and Molecular Diagnostic of Genetic Diseases - Department of Biophysics, Federal University of São Paulo, Rua Pedro de Toledo, 669 - 9o andar, São Paulo, 04039-032, Brazil
| | - Juliana G Pessoa
- Center for Research and Molecular Diagnostic of Genetic Diseases - Department of Biophysics, Federal University of São Paulo, Rua Pedro de Toledo, 669 - 9o andar, São Paulo, 04039-032, Brazil
| | - Marion C Braga
- Department of Psychobiology, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Vânia D'Almeida
- Department of Psychobiology, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Ana Maria Martins
- Reference Center in Inborn Errors of Metabolism, Pediatrics Department, Federal University of São Paulo, São Paulo, SP, Brazil
| | - João B Pesquero
- Center for Research and Molecular Diagnostic of Genetic Diseases - Department of Biophysics, Federal University of São Paulo, Rua Pedro de Toledo, 669 - 9o andar, São Paulo, 04039-032, Brazil.
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14
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Dorsal root ganglia volume is increased in patients with the Fabry-related GLA variant p.D313Y. J Neurol 2019; 266:1332-1339. [DOI: 10.1007/s00415-019-09262-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 02/24/2019] [Accepted: 02/26/2019] [Indexed: 10/27/2022]
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15
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Üçeyler N, Böttger J, Henkel L, Langjahr M, Mayer C, Nordbeck P, Wanner C, Sommer C. Detection of blood Gb3 deposits as a new tool for diagnosis and therapy monitoring in patients with classic Fabry disease. J Intern Med 2018; 284:427-438. [PMID: 29974530 DOI: 10.1111/joim.12801] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The X-linked Fabry disease (FD) is a multiorgan disorder due to alpha-galactosidase A (α-GAL) deficiency with consequent lysosomal accumulation of globotriaosylceramide (Gb3). We established the immunocytochemical detection of Gb3 in blood cells of FD patients as a new method for FD diagnostics, follow-up and treatment control. METHODS We enrolled 67 FD patients (37 men, 30 women) and 52 healthy controls (26 men, 26 women). PBMC were isolated from whole venous blood and 3x105 cells were immunoreacted with antibodies against CD77 as a marker for Gb3. Using fluorescence microscopy, the mean percentage of Gb3 positive PBMC was determined by an investigator blinded to subject allocation. As a second method, we qualitatively assessed Gb3 positive cells in blood smears. RESULTS Gb3 deposits were unequivocally visible in PBMC and in blood smears. Men (P < 0.001) and women (P < 0.01) with classical FD had more Gb3-positive PBMC than healthy controls, whose samples only occasionally showed positive cells. The number of Gb3 positive PBMC was negatively correlated with α-GAL activity and positively correlated with plasma lyso-Gb3 levels. Only the PBMC Gb3 load but not plasma lyso-Gb3 reflected short- and long-term effects of enzyme replacement therapy (P < 0.01). CONCLUSIONS Gb3 can be visualized in PBMC and blood smears and can be used as a novel marker for diagnostics, follow-up and treatment control in FD.
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Affiliation(s)
- N Üçeyler
- Department of Neurology, University of Würzburg, Würzburg, Germany.,Fabry Center for Interdisciplinary Therapy Würzburg (FAZIT), University of Würzburg, Würzburg, Germany
| | - J Böttger
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - L Henkel
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - M Langjahr
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - C Mayer
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - P Nordbeck
- Fabry Center for Interdisciplinary Therapy Würzburg (FAZIT), University of Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University of Würzburg, Würzburg, Germany
| | - C Wanner
- Fabry Center for Interdisciplinary Therapy Würzburg (FAZIT), University of Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University of Würzburg, Würzburg, Germany
| | - C Sommer
- Department of Neurology, University of Würzburg, Würzburg, Germany.,Fabry Center for Interdisciplinary Therapy Würzburg (FAZIT), University of Würzburg, Würzburg, Germany
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