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Goicoechea M, Gomez-Preciado F, Benito S, Torras J, Torra R, Huerta A, Restrepo A, Ugalde J, Astudillo DE, Agraz I, Lopez-Mendoza M, de Arriba G, Corchete E, Quiroga B, Gutierrez MJ, Martin-Conde ML, Lopes V, Ramos C, Mendez I, Cao M, Dominguez F, Ortiz A. Predictors of outcome in a Spanish cohort of patients with Fabry disease on enzyme replacement therapy. Nefrologia 2021; 41:652-660. [PMID: 36165155 DOI: 10.1016/j.nefroe.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/18/2021] [Indexed: 06/16/2023] Open
Abstract
UNLABELLED Fabry disease may be treated by enzyme replacement therapy (ERT), but the impact of chronic kidney disease (CKD) on the response to therapy remains unclear. The aim of the present study was to analyse the incidence and predictors of clinical events in patients on ERT. STUDY DESIGN Multicentre retrospective observational analysis of patients diagnosed and treated with ERT for Fabry disease. The primary outcome was the first renal, neurological or cardiological events or death during a follow-up of 60 months (24-120). RESULTS In 69 patients (42 males, 27 females, mean age 44.6±13.7 years), at the end of follow-up, eGFR and the left ventricular septum thickness remained stable and the urinary albumin: creatinine ratio tended to decrease, but this decrease only approached significance in patients on agalsidase-beta (242-128mg/g (p=0.05). At the end of follow-up, 21 (30%) patients had suffered an incident clinical event: 6 renal, 2 neurological and 13 cardiological (including 3 deaths). Events were more frequent in patients with baseline eGFR≤60ml/min/1.73m2 (log Rank 12.423, p=0.001), and this remained significant even after excluding incident renal events (log Rank 4.086, p=0.043) and in males and in females. Lower baseline eGFR was associated with a 3- to 7-fold increase the risk of clinical events in different Cox models. CONCLUSIONS GFR at the initiation of ERT is the main predictor of clinical events, both in males and in females, suggesting that start of ERT prior to the development of CKD is associated with better outcomes.
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Affiliation(s)
- Marian Goicoechea
- Servicio de Nefrología Hospital General Universitario Gregorio Marañon, Spain; Red de Investigación Renal (REDinRen), Fondos FEDER, Spain.
| | | | | | - Joan Torras
- Red de Investigación Renal (REDinRen), Fondos FEDER, Spain; Servicio de Nefrología Hospital Universitario de Bellvitge, Spain
| | - Roser Torra
- Red de Investigación Renal (REDinRen), Fondos FEDER, Spain; Servicio de Nefrología Fundacion Puigvert, Spain
| | - Ana Huerta
- Servicio de Nefrología Hospital Universitario Puerta del Hierro Majadahonda, Spain
| | | | - Jessica Ugalde
- Servicio de Nefrología Hospital Clinic de Barcelona, Spain
| | | | - Irene Agraz
- Servicio de Nefrología Hospital Vall d'Hebron, Spain
| | | | - Gabriel de Arriba
- Servicio de Nefrología Hospital General Universitario de Guadalajara, Universidad de Alcalá de Henares, Spain
| | | | - Borja Quiroga
- Servicio de Nefrología Hospital Universitario de la Princesa, Spain
| | | | | | - Vanessa Lopes
- Servicio de Nefrología del Hospital Universitario Ramon y Cajal, Spain
| | - Carmela Ramos
- Servicio de Nefrología del Hospital Clínico Universitario de Valencia, Spain
| | - Irene Mendez
- Servicio de Cardiología del Hospital General Universitario Gregorio Marañon, Spain
| | - Mercedes Cao
- Servicio de Nefrología Complexo Hospitalario Universitario A Coruña, Spain
| | | | - Alberto Ortiz
- Red de Investigación Renal (REDinRen), Fondos FEDER, Spain; Servicio de Nefrología de la Fundación Jimenez Diaz, Spain
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2
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Sanchez-Niño MD, Aguilera-Correa JJ, Politei J, Esteban J, Requena T, Ortiz A. Unraveling the drivers and consequences of gut microbiota disruption in Fabry disease: the lyso-Gb3 link. Future Microbiol 2021; 15:227-231. [PMID: 32271110 DOI: 10.2217/fmb-2019-0249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Maria D Sanchez-Niño
- Department of Nephrology and Hypertension, IIS-Fundación Jiménez Díaz, UAM. Av. Reyes Católicos, 2, 28040 Madrid, Spain
| | - John-Jairo Aguilera-Correa
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM. Av. Reyes Católicos, 2, 28040 Madrid, Spain
| | - Juan Politei
- Fundación Para el Estudio de las Enfermedades Neurometabólicas, Buenos Aires, Argentina
| | - Jaime Esteban
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM. Av. Reyes Católicos, 2, 28040 Madrid, Spain
| | - Teresa Requena
- Department of Food Biotechnology and Microbiology, Instituto de Investigación en Ciencias de la Alimentación, CIAL (CSIC-UAM), Nicolás Cabrera, 9, 28049 Madrid, Spain
| | - Alberto Ortiz
- Fundación Para el Estudio de las Enfermedades Neurometabólicas, Buenos Aires, Argentina
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3
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Goicoechea M, Gomez-Preciado F, Benito S, Torras J, Torra R, Huerta A, Restrepo A, Ugalde J, Astudillo DE, Agraz I, Lopez-Mendoza M, de Arriba G, Corchete E, Quiroga B, Gutierrez MJ, Martin-Conde ML, Lopes V, Ramos C, Mendez I, Cao M, Dominguez F, Ortiz A. Predictors of outcome in a Spanish cohort of patients with Fabry disease on enzyme replacement therapy. Nefrologia 2021; 41:S0211-6995(21)00031-X. [PMID: 33714629 DOI: 10.1016/j.nefro.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 11/21/2022] Open
Abstract
Fabry disease may be treated by enzyme replacement therapy (ERT), but the impact of chronic kidney disease (CKD) on the response to therapy remains unclear. The aim of the present study was to analyse the incidence and predictors of clinical events in patients on ERT. STUDY DESIGN Multicentre retrospective observational analysis of patients diagnosed and treated with ERT for Fabry disease. The primary outcome was the first renal, neurological or cardiological events or death during a follow-up of 60 months (24-120). RESULTS In 69 patients (42 males, 27 females, mean age 44.6±13.7 years), at the end of follow-up, eGFR and the left ventricular septum thickness remained stable and the urinary albumin: creatinine ratio tended to decrease, but this decrease only approached significance in patients on agalsidase-beta (242-128mg/g (p=0.05). At the end of follow-up, 21 (30%) patients had suffered an incident clinical event: 6 renal, 2 neurological and 13 cardiological (including 3 deaths). Events were more frequent in patients with baseline eGFR≤60ml/min/1.73m2 (log Rank 12.423, p=0.001), and this remained significant even after excluding incident renal events (log Rank 4.086, p=0.043) and in males and in females. Lower baseline eGFR was associated with a 3- to 7-fold increase the risk of clinical events in different Cox models. CONCLUSIONS GFR at the initiation of ERT is the main predictor of clinical events, both in males and in females, suggesting that start of ERT prior to the development of CKD is associated with better outcomes.
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Affiliation(s)
- Marian Goicoechea
- Servicio de Nefrología Hospital General Universitario Gregorio Marañon, Spain; Red de Investigación Renal (REDinRen), Fondos FEDER, Spain.
| | | | | | - Joan Torras
- Red de Investigación Renal (REDinRen), Fondos FEDER, Spain; Servicio de Nefrología Hospital Universitario de Bellvitge, Spain
| | - Roser Torra
- Red de Investigación Renal (REDinRen), Fondos FEDER, Spain; Servicio de Nefrología Fundacion Puigvert, Spain
| | - Ana Huerta
- Servicio de Nefrología Hospital Universitario Puerta del Hierro Majadahonda, Spain
| | | | - Jessica Ugalde
- Servicio de Nefrología Hospital Clinic de Barcelona, Spain
| | | | - Irene Agraz
- Servicio de Nefrología Hospital Vall d'Hebron, Spain
| | | | - Gabriel de Arriba
- Servicio de Nefrología Hospital General Universitario de Guadalajara, Universidad de Alcalá de Henares, Spain
| | | | - Borja Quiroga
- Servicio de Nefrología Hospital Universitario de la Princesa, Spain
| | | | | | - Vanessa Lopes
- Servicio de Nefrología del Hospital Universitario Ramon y Cajal, Spain
| | - Carmela Ramos
- Servicio de Nefrología del Hospital Clínico Universitario de Valencia, Spain
| | - Irene Mendez
- Servicio de Cardiología del Hospital General Universitario Gregorio Marañon, Spain
| | - Mercedes Cao
- Servicio de Nefrología Complexo Hospitalario Universitario A Coruña, Spain
| | | | - Alberto Ortiz
- Red de Investigación Renal (REDinRen), Fondos FEDER, Spain; Servicio de Nefrología de la Fundación Jimenez Diaz, Spain
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Carubbi F, Barbato A, Burlina AB, Francini F, Mignani R, Pegoraro E, Landini L, De Danieli G, Bruni S, Strazzullo P. Nutrition in adult patients with selected lysosomal storage diseases. Nutr Metab Cardiovasc Dis 2021; 31:733-744. [PMID: 33589321 DOI: 10.1016/j.numecd.2020.11.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 02/07/2023]
Abstract
Lysosomal storage disorders (LSDs) are a group of clinically heterogeneous disorders affecting the function of lysosomes and are characterized by an accumulation of undigested substrates within several cell types. In recent years there have been substantial advances in supportive care and drug treatment for some LSDs, leading to improved patient survival, as seen in Gaucher, Pompe and Fabry disease and some Mucopolysaccharidoses; however, many symptoms still persist. Thus it is now even more important to improve patients' quality of life and reduce symptoms and comorbidities. One potential way of achieving this goal is through adjunct nutritional therapy, which is challenging as patients may be overweight with associated consequences, or malnourished, or underweight. Furthermore, drugs used to treat LSDs can modify the metabolic status and needs of patients. There are currently not enough data to make specific dietary recommendations for individual LSDs; however, suggestions can be made for managing clinical manifestations of the diseases, as well as treatment-associated adverse events. The metabolic and nutritional status of adult patients must be regularly assessed and individualized dietary plans may be created to cater to a patient's specific needs. Damage to the autophagic process is a common feature in LSDs that is potentially sensitive to dietary manipulation and needs to be assessed in clinical studies.
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Affiliation(s)
- Francesca Carubbi
- U.O.C. Medicina metabolica AOU Modena, Metabolic Medicine Unit, Modena University Hospital, Modena, Italy.
| | - Antonio Barbato
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Alberto B Burlina
- U.O.C. Malattie Metaboliche Ereditarie, Major Operational Unit of Hereditary Metabolic Diseases, Azienda Ospedaliera di Padova, Padua, Italy
| | - Francesco Francini
- U.O. Nutrizione Clinica, Department of Medicine, Azienda Ospedaliera di Padova, Padua, Italy
| | - Renzo Mignani
- U.O. di Nefrologia e Dialisi dell'Ospedale Infermi di Rimini, Nephrology Operational Unit of the Infermi Hospital in Rimini, Rimini, Italy
| | - Elena Pegoraro
- Department of Neuroscience, University of Padova, Padua, Italy
| | - Linda Landini
- S.S.D. Dietetics and Clinical Nutrition ASL 4 Chiavarese Liguria - Sestri Levante Hospital, Italy
| | | | | | - Pasquale Strazzullo
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
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5
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Silva CAB, Moura-Neto JA, Dos Reis MA, Vieira Neto OM, Barreto FC. Renal Manifestations of Fabry Disease: A Narrative Review. Can J Kidney Health Dis 2021; 8:2054358120985627. [PMID: 33786192 PMCID: PMC7960898 DOI: 10.1177/2054358120985627] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/20/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose of review In this narrative review, we describe general aspects, histological alterations, treatment, and implications of Fabry disease (FD) nephropathy. This information should be used to guide physicians and patients in a shared decision-making process. Source of information Original peer-reviewed articles, review articles, and opinion pieces were identified from PubMed and Google Scholar databases. Only sources in English were accessed. Methods We performed a focused narrative review assessing the main aspects of FD nephropathy. The literature was critically analyzed from a theoretical and contextual perspective, and thematic analysis was performed. Key findings FD nephropathy is related to the progressive accumulation of GL3, which occurs in all types of renal cells. It is more prominent in podocytes, which seem to play an important role in the pathogenesis of this nephropathy. A precise detection of renal disorders is of fundamental importance because the specific treatment of FD is usually delayed, making reversibility unlikely and leading to a worse prognosis. Limitations As no formal tool was applied to assess the quality of the included studies, selection bias may have occurred. Nonetheless, we have attempted to provide a comprehensive review on the topic using current studies from experts in FD and extensive review of the literature.
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Affiliation(s)
| | | | - Marlene Antônia Dos Reis
- Nephropathology Service, General Pathology, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Osvaldo Merege Vieira Neto
- Nephrology Service, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Fellype Carvalho Barreto
- Nephrology Service, Department of Internal Medicine, Federal University of Paraná, Curitiba, Brazil
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Affiliation(s)
- Einar Svarstad
- Department of Medicine, Haukeland University Hospital, Bergen, Norway; and .,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hans Peter Marti
- Department of Medicine, Haukeland University Hospital, Bergen, Norway; and.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Ramos AM, Fernández-Fernández B, Pérez-Gómez MV, Carriazo Julio SM, Sanchez-Niño MD, Sanz A, Ruiz-Ortega M, Ortiz A. Design and optimization strategies for the development of new drugs that treat chronic kidney disease. Expert Opin Drug Discov 2019; 15:101-115. [PMID: 31736379 DOI: 10.1080/17460441.2020.1690450] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Chronic kidney disease (CKD) is characterized by increased risks of progression to end-stage kidney disease requiring dialysis and cardiovascular mortality, predicted to be among the five top causes of death by 2040. Only the design and optimization of novel strategies to develop new drugs to treat CKD will contain this trend. Current therapy for CKD includes nonspecific therapy targeting proteinuria and/or hypertension and cause-specific therapies for diabetic kidney disease, autosomal dominant polycystic kidney disease, glomerulonephritides, Fabry nephropathy, hemolytic uremic syndrome and others.Areas covered: Herein, the authors review the literature on new drugs under development for CKD as well as novel design and development strategies.Expert opinion: New therapies for CKD have become a healthcare priority. Emerging therapies undergoing clinical trials are testing expanded renin-angiotensin system blockade with double angiotensin receptor/endothelin receptor blockers, SGLT2 inhibition, and targeting inflammation, the immune response, fibrosis and the Nrf2 transcription factor. Emerging therapeutic targets include cell senescence, complement activation, Klotho expression preservation and microbiota. Novel approaches include novel model systems that can be personalized (e.g. organoids), unbiased systems biology-based identification of new therapeutic targets, drug databases that speed up drug identification and repurposing, nanomedicines that improve drug delivery and RNA targeting to expand the number of targetable proteins.
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Affiliation(s)
- Adrián M Ramos
- Laboratory of Nephrology and Hypertension, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz (IIS-FJD), School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.,Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Fernández-Fernández
- Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain.,Nephrology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz (IIS-FJD), School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Vanessa Pérez-Gómez
- Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Investigación Sanitaria-Fundación Jiménez Díaz (IIS-FJD), School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Sol María Carriazo Julio
- Nephrology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz (IIS-FJD), School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Dolores Sanchez-Niño
- Laboratory of Nephrology and Hypertension, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz (IIS-FJD), School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.,Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Sanz
- Laboratory of Nephrology and Hypertension, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz (IIS-FJD), School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.,Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Ruiz-Ortega
- Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain.,Laboratory of Renal and Vascular Pathology and Diabetes, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz (IIS-FJD), School of Medicine, Universidad Autónoma de Madrid and Cellular Biology in Renal Diseases Laboratory, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alberto Ortiz
- Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Investigación Sanitaria-Fundación Jiménez Díaz (IIS-FJD), School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.,Fundación Renal Iñigo Álvarez de Toledo IRSIN C/José Abascal, Madrid, Spain
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