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Segura Schmitz L, Hennermann JB, Lollert A. [Lysosomal storage disorders - Fabry disease and Gaucher disease]. Dtsch Med Wochenschr 2024; 149:1263-1269. [PMID: 39384207 DOI: 10.1055/a-2295-1592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2024]
Abstract
Lysosomal storage disorders (LSD) are a heterogenous group of inborn errors of metabolism due to lysosomal malfunction. LSDs affect 1 in 5000 live births, albeit every LSD itself has a low incidence. The most common LSDs are Fabry disease and Gaucher disease. The underlying cause mainly is an enzyme deficiency but may also be due to defects in transport or activation proteins, which result in progressive intra- and extra-lysosomal accumulation of undegraded storage material. The lysosomes play a key role in degradation and cellular recycling of macromolecules. Besides disturbance of cellular function, substrate accumulation may result in secondary toxic and/or inflammatory processes. For treatment of Fabry and Gaucher disease, several therapeutic approaches are approved including enzyme replacement therapy, chaperon therapy for Fabry disease and substrate reduction therapy for Gaucher disease.
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Lerario S, Monti L, Ambrosetti I, Luglio A, Pietra A, Aiello V, Montanari F, Bellasi A, Zaza G, Galante A, Salera D, Capelli I, La Manna G, Provenzano M. Fabry disease: a rare disorder calling for personalized medicine. Int Urol Nephrol 2024; 56:3161-3172. [PMID: 38613662 PMCID: PMC11405476 DOI: 10.1007/s11255-024-04042-4] [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: 02/15/2024] [Accepted: 03/25/2024] [Indexed: 04/15/2024]
Abstract
Fabry Disease (FD) is a genetic disease caused by a deficiency in the activity of lysosomal galactosidase A (α-GalA), an enzyme responsible for the catabolism of globotriaosylceramide (Gb3). Since lysosomes are present throughout the body and play a crucial role in catabolism and recycling of cytosolic compounds, FD can affect multiple organs and result in various symptoms, including renal, cardiovascular, neurological, cutaneous, and ophthalmic manifestations. Due to the nonspecific symptoms and the rarity of FD, it is often diagnosed late in life. However, introducing targeted therapies such as enzyme replacement therapy (ERT) and chaperone therapy has significantly improved FD's natural history and prognosis by restoring α-GalA enzyme activity. Despite the advancements, there are limitations to the currently available therapies, which has prompted research into new potential treatments for FD, including alternative forms of enzyme replacement therapy, substrate reduction therapy, mRNA therapy, and genetic therapy. In this review, we analyze the epidemiology, pathophysiology, and treatment of FD, with particular emphasis on promising therapeutic opportunities that could shift the treatment of this rare disease from a standardized to a personalized approach soon.
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Affiliation(s)
- Sarah Lerario
- Nephrology, Dialysis, and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Luigi Monti
- Medical Genetics Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Irene Ambrosetti
- Medical Genetics Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Agnese Luglio
- Medical Genetics Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Andrea Pietra
- Medical Genetics Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Valeria Aiello
- Nephrology, Dialysis, and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Francesca Montanari
- Medical Genetics Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Antonio Bellasi
- Servizio Di Nefrologia, Ospedale Regionale Di Lugano, Ente Ospedaliero Cantonale, Ospedale CivicoVia Tesserete 46, 6903, Lugano, Switzerland
- Università Della Svizzera Italiana (USI), Lugano, Switzerland
| | - Gianluigi Zaza
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036, Rende, CS, Italy
| | - Antonio Galante
- Università Della Svizzera Italiana (USI), Lugano, Switzerland
| | - Davide Salera
- Servizio Di Nefrologia, Ospedale Regionale Di Lugano, Ente Ospedaliero Cantonale, Ospedale CivicoVia Tesserete 46, 6903, Lugano, Switzerland
| | - Irene Capelli
- Nephrology, Dialysis, and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.
| | - Gaetano La Manna
- Nephrology, Dialysis, and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.
| | - Michele Provenzano
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036, Rende, CS, Italy
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Lin CJ, Yang FJ, Wu CJ, Wu MJ, Wu MS. Insights of Fabry disease: Expert consensus approach for screening, diagnosis, and multidisciplinary management in chronic kidney disease. J Formos Med Assoc 2024:S0929-6646(24)00453-4. [PMID: 39358116 DOI: 10.1016/j.jfma.2024.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 08/15/2024] [Accepted: 09/22/2024] [Indexed: 10/04/2024] Open
Abstract
The prevalence of Fabry disease (FD) among males with chronic kidney disease (CKD) of unknown etiology in Taiwan is 0.6%. Despite this, FD is frequently overlooked in clinical settings. To address this issue, two consensus meetings were conducted in Taiwan-one in August 2022 and another in April 2023. The first meeting established screening criteria based on age, gender, family history, cardiac involvement, and symptoms. The second meeting, with a multidisciplinary team, developed treatment recommendations. The consensus emphasizes the importance of proactive data collection in dialysis units and outpatient follow-ups to enhance FD detection and management. The screening algorithm recommends incorporating FD screening into the diagnostic process for CKD patients, regardless of age. Priority is given to patients with a family history of FD, early stroke history, or classical FD symptoms. Comprehensive screening is also advised for CKD patients without obvious classical symptoms. Screening protocols for males include measuring α-galactosidase A enzyme activity, with reduced activity leading to further tests such as lyso-Gb3 level quantification and genetic analysis. For females, the protocol involves evaluating lyso-Gb3 plasma levels and genetic testing. FD, though often underestimated, is more prevalent than recognized and necessitates a multidisciplinary approach for timely diagnosis. Enhancing awareness and adopting a comprehensive approach are essential for improving patient outcomes.
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Affiliation(s)
- Cheng-Jui Lin
- Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Feng-Jung Yang
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Yunlin Branch, Douliu, Taiwan
| | - Chih-Jen Wu
- Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
| | - Ming-Ju Wu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
| | - Mai-Szu Wu
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Sens F, Guittard L, Knebelmann B, Moranne O, Choukroun G, de Précigout V, Couchoud C, Deleruyelle I, Lancelot L, Tran Thi Phuong L, Ghafari T, Juillard L, Germain DP. Prevalence of Fabry Disease in Patients on Dialysis in France. Int J Mol Sci 2024; 25:10104. [PMID: 39337589 PMCID: PMC11432483 DOI: 10.3390/ijms251810104] [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: 08/07/2024] [Revised: 08/25/2024] [Accepted: 08/26/2024] [Indexed: 09/30/2024] Open
Abstract
Numerous prevalence studies on Fabry disease (FD, OMIM #301500) have been conducted in dialysis populations across the world with variable and controversial results. The FABRYDIAL study aimed to estimate the prevalence of FD in patients aged 18 to 74 years on chronic dialysis in France. This cross-sectional study was conducted in patients undergoing dialysis. One hundred and twenty-four dialysis centers participated. Patients with proven causes of nephropathy unrelated to FD were excluded. Alpha-galactosidase A activity was assayed in men, and both α-galactosidase A and lyso-Gb3 were assayed in women from dried blood spots. GLA gene sequencing was performed in case of abnormal values. If a variant was identified, a diagnosis validation committee was consulted for adjudication. Among the 6032 targeted patients, 3088 were included (73.6% of the eligible patients). Biochemical results were available for 2815 (1721 men and 1094 women). A genetic variant of GLA was identified in five patients: a benign c.937G>T/p.(Asp313Tyr) variant in two individuals, a likely benign c.427G>A/(p.Ala143Thr) variant, a likely benign c.416A>G/(p.Asn139Ser) variant, and a pathogenic c.1185dupG/p.Phe396Glyfs variant. Among the screened patients, the prevalence was 0.058% [0.010;0.328] in males, 0% [0.000;0.350] in females, and 0.035% [0.006;0.201] when both genders were pooled. Among all patients aged 18-74 years undergoing dialysis without a previously known cause of nephropathy unlinked to FD, the prevalence was 0.028% [0.006;0.121]. The prevalence of FD in a cohort of French dialysis patients was low. However, considering the prognostic impact of earlier diagnosis, signs of FD should be sought in patients with nephropathies of uncertain etiology.
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Affiliation(s)
- Florence Sens
- Service de Néphrologie et d’Explorations Fonctionnelles, Hôpital Edouard Herriot, Hospices Civils de Lyon, F-69003 Lyon, France; (F.S.); (L.J.)
- UMR Inserm 1060, Université Claude Bernard Lyon 1, F-69621 Villeurbanne, France
| | - Laure Guittard
- Service Recherche et Epidémiologie Cliniques, Pôle Santé Publique, Hospices Civils de Lyon, F-69002 Lyon, France; (L.G.); (I.D.); (L.L.)
- Research on Healthcare Performance (RESHAPE), Inserm U1290, Université Claude Bernard Lyon, F-69373 Lyon, France
| | - Bertrand Knebelmann
- Service de Néphrologie, Hôpital Necker, Assistance Publique Hôpitaux de Paris, Université de Paris, F-75015 Paris, France;
| | - Olivier Moranne
- Service Néphrologie-Dialyse-Apherese, Hôpital Universitaire Caremeau, IDESP Université de Montpellier, F-30029 Nîmes, France;
| | - Gabriel Choukroun
- Service de Néphrologie, Médecine Interne, Dialyse et Transplantation, CHU Amiens, F-80054 Amiens, France;
| | - Valérie de Précigout
- Service de Néphrologie, Hôpital Pellegrin, CHU Bordeaux, F-33076 Bordeaux, France;
| | - Cécile Couchoud
- Coordination Nationale Réseau Epidémiologique et Information en Néphrologie, Agence de la Biomédecine, F-93212 Saint-Denis-La-Plaine, France;
| | - Isabelle Deleruyelle
- Service Recherche et Epidémiologie Cliniques, Pôle Santé Publique, Hospices Civils de Lyon, F-69002 Lyon, France; (L.G.); (I.D.); (L.L.)
| | - Léa Lancelot
- Service Recherche et Epidémiologie Cliniques, Pôle Santé Publique, Hospices Civils de Lyon, F-69002 Lyon, France; (L.G.); (I.D.); (L.L.)
| | - Liên Tran Thi Phuong
- “Geneo” Referral Center for Fabry Disease and Lysosomal Diseases, MetabERN European Reference Network, F-92380 Garches, France;
| | - Thomas Ghafari
- Division of Medical Genetics, APHP—Paris Saclay University, F-92380 Garches, France;
| | | | - Laurent Juillard
- Service de Néphrologie et d’Explorations Fonctionnelles, Hôpital Edouard Herriot, Hospices Civils de Lyon, F-69003 Lyon, France; (F.S.); (L.J.)
- UMR Inserm 1060, Université Claude Bernard Lyon 1, F-69621 Villeurbanne, France
| | - Dominique P. Germain
- “Geneo” Referral Center for Fabry Disease and Lysosomal Diseases, MetabERN European Reference Network, F-92380 Garches, France;
- Division of Medical Genetics, APHP—Paris Saclay University, F-92380 Garches, France;
- Division of Medical Genetics, University of Versailles, F-78180 Montigny, France
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Alfadhel M, Al Sannaa N, Sunbul R, Al-Khawaja H, Askandarani S, Alanzi T, Elawad M, Fourtounas K. Experts' Opinion in Fabry Disease Management and the Unmet Medical Need: The Saudi Perspective. Ther Clin Risk Manag 2024; 20:641-652. [PMID: 39290672 PMCID: PMC11407309 DOI: 10.2147/tcrm.s475744] [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: 04/26/2024] [Accepted: 08/26/2024] [Indexed: 09/19/2024] Open
Abstract
Fabry disease (FD) is an X-linked lysosomal storage disorder caused by α-galactosidase A gene mutations. Its global incidence ranges from 1:40,000 to 1:170,000. This expert review evaluates the available guidelines, the status of diagnosed but untreated patients with FD, and the challenges in diagnosing and managing FD in the Kingdom of Saudi Arabia (KSA). An advisory board meeting (ABM) was conducted in two phases, with a survey that aimed to receive insights on the current unmet needs in the management of patients with FD in November 2022, and a second, offline meeting in February 2023. The goal of this ABM was to discuss current unmet needs in the management of Fabry patients in the Kingdom of Saudi Arabia. In the first ABM, experts opined on the best practices in the diagnosis, screening, and management of FD for healthcare professionals. These opinions on the management of FD relied on data from research and expert clinical judgments. In the second ABM, the same panel discussed different aspects of FD diagnosis, treatment, and management in the member countries of the Gulf Cooperation Council. The experts discussed the stigma associated with FD, patient awareness and knowledge, genetic screening, biomarkers, and home infusion therapy. They reviewed international guidelines and clinical criteria for enzyme replacement therapy (ERT). Furthermore, they also discussed the diagnosis of FD in men and women, the current guidelines followed for monitoring patients with FD, monitoring untreated patients with FD, Fabry Stabilization IndeX (FASTEX) as an assessment tool for the diagnosis of FD, FD management in KSA, challenges encountered while prescribing ERT in patients with FD, and the clinical criteria for starting ERT. The discussions led to the conclusion that currently, ERT is the only available therapy to manage FD and research should be focused on the early diagnosis and management of FD.
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Affiliation(s)
- Majid Alfadhel
- Medical Genomics Research Department, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs (MNG-HA), Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University or Health Sciences (KSAU-HS), Ministry of National Guard Health Affairs (MNG-HA), Riyadh, Saudi Arabia
- Genetics and Precision Medicine Department (GPM), King Abdullah Specialized Children's Hospital (KASCH), King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNG-HA), Riyadh, Saudi Arabia
| | | | - Rawda Sunbul
- Medical Genetic Unit, Pediatric Department, Qatif Central Hospital, Qatif, Saudia Arabia
| | - Huda Al-Khawaja
- Maternity and Children Hospital, Al Mubarraz, Al-Ahsa, Kingdom of Saudia Arabia
| | - Sumayah Askandarani
- Multiorgan Transplant Center, King Fahad Specialist Hospital, Dammam, Eastern Province, Saudi Arabia
| | - Talal Alanzi
- Division of Clinical Genetics and Metabolic, Department of Pediatrics, Prince Sultan Medical City, Riyadh, Saudi Arabia
| | - Mamoun Elawad
- Prince Sultan Military Medical City, Riyadh, Kingdom of Saudia Arabia
| | - Konstantinos Fourtounas
- Prince Sultan Kidney Center, King Salman Armed Forces Hospital, Tabuk, Kingdom of Saudia Arabia
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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] [MESH Headings] [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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Hung CL, Wu YW, Kuo L, Sung KT, Lin HH, Chang WT, Chang CH, Lai CH, Huang CY, Wang CL, Lin CC, Juang JMJ, Chen PS, Wang CY, Chang HC, Chu CY, Wang WH, Tseng H, Kao YT, Wang TD, Yu WC, Chen WJ. 2024 Update of the TSOC Expert Consensus of Fabry Disease. ACTA CARDIOLOGICA SINICA 2024; 40:544-568. [PMID: 39308653 PMCID: PMC11413953 DOI: 10.6515/acs.202409_40(5).20240731a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Accepted: 07/31/2024] [Indexed: 09/25/2024]
Abstract
As an X-linked inherited lysosomal storage disease that is caused by α-galactosidase A gene variants resulting in progressive accumulation of pathogenic glycosphingolipid (Gb3) accumulation in multiple tissues and organs, Fabry disease (FD) can be classified into classic or late-onset phenotypes. In classic phenotype patients, α-galactosidase A activity is absent or severely reduced, resulting in a more progressive disease course with multi-systemic involvement. Conversely, late-onset phenotype, often with missense variants (e.g., IVS4+919G>A) in Taiwan, may present with a more chronic clinical course with predominant cardiac involvement (cardiac subtype), as they tend to have residual enzyme activity, remaining asymptomatic or clinically silent during childhood and adolescence. In either form, cardiac hypertrophy remains the most common feature of cardiac involvement, potentially leading to myocardial fibrosis, arrhythmias, and heart failure. Diagnosis is established through α-galactosidase enzyme activity assessment or biomarker analyisis (globotriaosylsphingosine, Lyso-Gb3), advanced imaging modalities (echocardiography and cardiac magnetic resonance imaging), and genotyping to differentiate FD from other cardiomyopathy. Successful therapeutic response relies on early recognition and by disease awareness from typical features in classic phenotype and cardiac red flags in cardiac variants for timely therapeutic interventions. Recent advances in pharmacological approach including enzyme replacement therapy (agalsidase alfa or beta), oral chaperone therapy (migalastat), and substrate reduction therapy (venglustat) aim to prevent from irreversible organ damage. Genotype- and gender-based monitoring of treatment effects through biomarker (Lyso-Gb3), renal assessment, and cardiac responses using advanced imaging modalities are key steps to optimizing patient care in FD.
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Affiliation(s)
- Chung-Lieh Hung
- Institute of Biomedical Sciences, MacKay Medical College, New Taipei City
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei
| | - Yen-Wen Wu
- Division of Cardiology, Cardiovascular Medical Center, and Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City
- Department of Internal Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan
| | - Ling Kuo
- Department of Internal Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei
| | - Kuo-Tzu Sung
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei
- Department of Medicine, MacKay Medical College
| | - Heng-Hsu Lin
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City
| | - Wei-Ting Chang
- School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan
| | - Chia-Hsiu Chang
- Division of Cardiology, Cardiovascular Center, Cathay General Hospital, Taipei
| | - Chih-Hung Lai
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University
| | - Chun-Yao Huang
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Research Center, Taipei Medical University Hospital
- Taipei Heart institute, Taipei Medical University, Taipei
| | - Chun-Li Wang
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan
| | - Chih-Chan Lin
- Division of Cardiology, Department of Internal Medicine, An Nan Hospital, China Medical University, Tainan
| | - Jyh-Ming Jimmy Juang
- Heart Failure Center and Division of Cardiology, Department of Internal Medicine, Center of Genetic Heart Diseases, National Taiwan University Hospital
- Department of Medicine, National Taiwan University College of Medicine, Taipei
| | - Po-Sheng Chen
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan
| | - Chao-Yung Wang
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan
- Institute of Cellular and System Medicine, National Health Research Institutes, Miaoli
- Department of Medical Science, National Tsing Hua University, Hsinchu
| | - Hao-Chih Chang
- Department of Internal Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei
- Department of Medicine, Taipei Veterans General Hospital Taoyuan Branch, Taoyuan
| | - Chun-Yuan Chu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
| | - Wen-Hwa Wang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Hsinyu Tseng
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu
| | - Yung-Ta Kao
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Research Center, Taipei Medical University Hospital
- Taipei Heart institute, Taipei Medical University, Taipei
| | - Tzung-Dau Wang
- Department of Medicine, National Taiwan University College of Medicine, Taipei
- Division of Cardiology, Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan
| | - Wen-Chung Yu
- Department of Internal Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Jone Chen
- Division of Cardiology, Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan
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Gjorgjievski N, Karanfilovski V, Arsov T, Vidimliski PD, Andreevska GS, Selim G, Dejanov P, Jordanova V, Marinova I, Paskalev E, Nikolov IG. Case report: First diagnosis of Fabry disease in North Macedonia in a patient presenting with kidney failure on hemodialysis. Front Genet 2024; 15:1415906. [PMID: 39205943 PMCID: PMC11349674 DOI: 10.3389/fgene.2024.1415906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 07/18/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction Fabry disease is a rare X-linked lysosomal storage disorder caused by α-galactosidase A (α-Gal A) deficiency. Reduced or absent enzyme activity causes progressive lysosomal accumulation of globotriaosylceramide (Lyso-Gb3) in various cells throughout the body to trigger inflammation and fibrosis. Case description We present the first familial case of Fabry Disease in North Macedonia identified based on clinical manifestations and confirmed through enzyme, biomarker, and genetic tests. The index case in the family was a 45-year-old male undergoing hemodialysis therapy. He has had chronic burning uncontrolled limb pain since childhood, intermittent abdominal cramps, anhidrosis, and hypertension. The constellation of clinical presentations accompanied by similar symptoms in close family members prompted the enzyme, biomarker, and genetic analyses for Fabry disease. Genetic testing identified a known pathogenic GLA missense variant c.443G>A or p.(Ser148Asn) in the hemizygous state. Subsequent family studies allowed identification of another hemizygous male and five heterozygous female carriers affected by this X-linked disorder. Conclusion We report identification of the first familial case of Fabry disease in North Macedonia and describe the phenotype associated with the Ser148Asn GLA variant. Greater awareness of this rare disease linked to continuous medical education is crucial for timely diagnosis and treatment.
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Affiliation(s)
- Nikola Gjorgjievski
- Faculty of Medicine Ss. Cyril and Methodius in Skopje, University Hospital of Nephrology, Skopje, North Macedonia
| | - Vlatko Karanfilovski
- Faculty of Medicine Ss. Cyril and Methodius in Skopje, University Hospital of Nephrology, Skopje, North Macedonia
| | - Todor Arsov
- Faculty of Medical Sciences, University Goce Delcev in Shtip, Stip, North Macedonia
| | - Pavlina Dzekova Vidimliski
- Faculty of Medicine Ss. Cyril and Methodius in Skopje, University Hospital of Nephrology, Skopje, North Macedonia
| | - Galisna Severeova Andreevska
- Faculty of Medicine Ss. Cyril and Methodius in Skopje, University Hospital of Nephrology, Skopje, North Macedonia
| | - Gjulshen Selim
- Faculty of Medicine Ss. Cyril and Methodius in Skopje, University Hospital of Nephrology, Skopje, North Macedonia
| | - Petar Dejanov
- Faculty of Medicine Ss. Cyril and Methodius in Skopje, University Hospital of Nephrology, Skopje, North Macedonia
| | - Vasilena Jordanova
- Department of Nephrology and Transplantation University Hospital "Alexandrovska", Sofia, Bulgaria
| | - Ivelina Marinova
- Department of Nephrology and Transplantation University Hospital "Alexandrovska", Sofia, Bulgaria
| | - Emil Paskalev
- Department of Nephrology and Transplantation University Hospital "Alexandrovska", Sofia, Bulgaria
| | - Igor G Nikolov
- Faculty of Medicine Ss. Cyril and Methodius in Skopje, University Hospital of Nephrology, Skopje, North Macedonia
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9
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Kaur S, Bhalla JS, Erwin AL, Jaber W, Wang TKM. Contemporary Multimodality Imaging for Diagnosis and Management of Fabry Cardiomyopathy. J Clin Med 2024; 13:4771. [PMID: 39200913 PMCID: PMC11355474 DOI: 10.3390/jcm13164771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 07/30/2024] [Accepted: 08/05/2024] [Indexed: 09/02/2024] Open
Abstract
Fabry disease (FD) is an X-linked lysosomal storage disorder which leads to the accumulation of globotriaosylceramide (Gb3) in various organs, including the heart. FD can be subdivided into classic disease resulting from negligible residual enzyme activity and a milder, atypical phenotype with later onset and less severe clinical presentation. The use of multimodality cardiac imaging including echocardiography, cardiac magnetic resonance and nuclear imaging is important for the diagnostic and prognostic evaluation in these patients. There are gaps in the literature regarding the comprehensive description of cardiac findings of FD and its evaluation by multimodality imaging. In this review, we describe the contemporary practices and roles of multimodality cardiac imaging in individuals affected with Fabry disease.
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Affiliation(s)
- Simrat Kaur
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Sydell and Arnold Miller, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.K.); (W.J.)
| | - Jaideep Singh Bhalla
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44106, USA;
| | - Angelika L. Erwin
- Department of Medical Genetics and Genomics, Cleveland Clinic Foundation, Cleveland, OH 44195, USA;
| | - Wael Jaber
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Sydell and Arnold Miller, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.K.); (W.J.)
| | - Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Sydell and Arnold Miller, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.K.); (W.J.)
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10
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Chang HC, Kuo L, Sung SH, Niu DM, Yu WC. Prognostic Implications of Left Ventricular Hypertrophy and Mechanical Function in Fabry Disease: A Longitudinal Cohort Study. J Am Soc Echocardiogr 2024; 37:787-796. [PMID: 38704103 DOI: 10.1016/j.echo.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND The prognostic value of different grades of left ventricular hypertrophy (LVH) and left ventricular (LV) mechanical function in Fabry disease is unclear. We aimed to evaluate the association between the severity of LVH, LV mechanical function, and clinical outcomes in Fabry disease. METHODS We conducted a retrospective cohort study from a single-center registry of adult patients with Fabry disease. Left ventricular mass index (LVMI) was measured by echocardiography. The severity of LVH was categorized by LVMI using the sex-specific cutoff values. Left ventricular mechanical function was measured as LV global longitudinal strain (GLS) by speckle-tracking analysis. The primary outcome was a composite of major adverse cardiovascular events (MACE) at 5 years, including heart failure hospitalization, sustained ventricular tachycardia, acute ischemic stroke, and all-cause mortality. RESULTS The study included 268 patients (age 50.4 ± 15.4 years, men 46.6%) with Fabry disease (83.2% IVS4+919G > A mutation), and 106 patients (39.6%) had LVH. Patients with mild, moderate, or severe LVH had 5-year MACE rates of 7.4%, 10%, and 30.5%, respectively (P < .001). Moreover, patients with impaired LV GLS (<14.1%) had a higher 5-year MACE rate than those with preserved LV GLS (32.1% vs 2.4%, P < .001). Severe LVH was an independent predictor of MACE compared with absence of LVH (adjusted hazard ratio, 12.73; 95% CI, 1.3-124.71; P = .03), after adjusting for age, sex, hypertension, hyperlipidemia, atrial fibrillation, renal function, average E/e', enzyme replacement therapy, and LV GLS. Patients with severe LVH and impaired LV GLS had the highest incidence for MACE (log-rank P < .05), irrespective of sex, genotypes, and whether receiving enzyme replacement therapy or not. CONCLUSIONS Sex-specific grading of LVH by LVMI is practical for risk stratification in patients with Fabry disease, and impaired LV GLS further refines the prognostication.
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Affiliation(s)
- Hao-Chih Chang
- Department of Medicine, Taipei Veterans General Hospital Taoyuan Branch, Taoyuan, Taiwan; Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei Taiwan; Department of Internal Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ling Kuo
- Department of Internal Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Hsien Sung
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei Taiwan; Department of Internal Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Dau-Ming Niu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Chung Yu
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei Taiwan; Department of Internal Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
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11
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Hughes DA, Sunder-Plassmann G, Jovanovic A, Brand E, West ML, Bichet DG, Pisani A, Nowak A, Torra R, Khan A, Azevedo O, Lehman A, Linhart A, Rutecki J, Giuliano JD, Krusinska E, Nordbeck P. Renal and multisystem effectiveness of 3.9 years of migalastat in a global real-world cohort: Results from the followME Fabry Pathfinders registry. J Inherit Metab Dis 2024. [PMID: 39031114 DOI: 10.1002/jimd.12771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 07/22/2024]
Abstract
Fabry disease is a progressive, X-linked lysosomal disorder caused by reduced or absent α-galactosidase A activity due to GLA variants. The effects of migalastat were examined in a cohort of 125 Fabry patients with migalastat-amenable GLA variants in the followME Pathfinders registry (EUPAS20599), an ongoing, prospective, patient-focused registry evaluating outcomes for current Fabry disease treatments. We report annualised estimated glomerular filtration rate (eGFR) and Fabry-associated clinical events (FACEs) in a cohort of patients who had received ≥3 years of migalastat treatment in a real-world setting. As of August 2022, 125 patients (60% male) had a mean migalastat exposure of 3.9 years. At enrolment, median age was 58 years (males, 57; females, 60) with a mean eGFR of 83.7 mL/min/1.73 m2 (n = 122; males, 83.7; females, 83.8) and a median left ventricular mass index of 115.1 g/m2 (n = 61; males, 131.2; females, 98.0). Mean (95% confidence interval) eGFR annualised rate of change in the overall cohort (n = 116) was -0.9 (-10.8, 9.9) mL/min/1.73 m2/year with a similar rate of change observed across patients with varying levels of kidney function at enrolment. Despite population age and baseline morbidity, 80% of patients did not experience a FACE during the mean 3.9 years of migalastat exposure. The incidence of renal, cardiac, and cerebrovascular events was 2.0, 83.2, and 4.1 events per 1000 patient-years, respectively. These data support a role of migalastat in preserving renal function and multisystem effectiveness during ≥3 years of migalastat treatment in this real-world Fabry population.
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Affiliation(s)
- Derralynn A Hughes
- Lysosomal Storage Disorders Unit, Royal Free London NHS Foundation Trust and University College London, London, UK
| | - Gere Sunder-Plassmann
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Ana Jovanovic
- Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Eva Brand
- Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, Interdisciplinary Fabry Center Münster, University Hospital Münster, Münster, Germany
| | - Michael L West
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Daniel G Bichet
- Department of Medicine, Hôpital du Sacré-Coeur, University of Montréal, Montréal, Quebec, Canada
| | - Antonio Pisani
- Department of Public Health, Nephrology Unit, Federico II University Hospital, Naples, Italy
| | - Albina Nowak
- Department of Endocrinology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Roser Torra
- Inherited Kidney Diseases, Nephrology Department, Fundació Puigvert, Institut d'Investigacions Biomèdiques (IIB-Snt Pau), Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Aneal Khan
- M.A.G.I.C. (Metabolics and Genetics in Canada) Clinic Ltd., Calgary, Alberta, Canada
| | - Olga Azevedo
- Cardiology Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Anna Lehman
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aleš Linhart
- Second Department of Internal Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | | | | | - Eva Krusinska
- Amicus Therapeutics, Inc., Princeton, New Jersey, USA
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12
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Javed M, Goswami DK, Raj H, Lohana K, Goswami B, Karim A, Warayo A, Farooqi P, Alamy H, Ullah ZO, Mohammad A, Farooqi SA, Ali H, Shuja D, Malik J, Baloch ZQ. Cardiac Manifestations in Inherited Metabolic Diseases. Cardiol Rev 2024:00045415-990000000-00299. [PMID: 38980048 DOI: 10.1097/crd.0000000000000753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Inherited metabolic diseases (IMDs) stem from genetic defects affecting enzyme function within specific metabolic pathways, collectively constituting rare conditions with an incidence of less than 1/100,000 births. While IMDs typically manifest with multisystemic symptoms, cardiac manifestations are common, notably hypertrophic cardiomyopathy. Additionally, they can lead to dilated or restrictive cardiomyopathy, as well as noncompacted left ventricular cardiomyopathy. Rhythm disturbances such as atrioventricular conduction abnormalities, Wolff-Parkinson-White syndrome, and ventricular arrhythmias, along with valvular pathologies and ischemic coronary issues, are also prevalent. This study aims to provide a narrative review of IMDs associated with cardiac involvement, delineating the specific cardiac manifestations of each disorder alongside systemic symptoms pivotal for diagnosis.
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Affiliation(s)
- Mubeena Javed
- From the Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Danish Kumar Goswami
- Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Hem Raj
- Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Kiran Lohana
- Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Barkha Goswami
- Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Ali Karim
- Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Allah Warayo
- Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Palwasha Farooqi
- Department of Medicine, Kabul University of Medical Sciences, Kabul, Afghanistan
| | - Haroon Alamy
- Department of Medicine, Kabul University of Medical Sciences, Kabul, Afghanistan
| | - Zainab Obaid Ullah
- Department of Medicine, Fatima Jinnah Medical University, Lahore, Pakistan
| | - Aamer Mohammad
- Department of Medicine, Rajiv Gandhi University of Health Sciences, Bengaluru, India
| | - Syed Ahmad Farooqi
- Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Hafsah Ali
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Darab Shuja
- Department of Medicine, Services Hospital, Lahore, Pakistan
| | - Jahanzeb Malik
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan
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13
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Harale M, Oommen AB, Mundada M, Faruqi AA, Patil S. An Atypical Presentation of Fabry Disease in a Patient With Nephrotic Syndrome: A Case Report. Cureus 2024; 16:e63661. [PMID: 39092329 PMCID: PMC11293037 DOI: 10.7759/cureus.63661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 07/02/2024] [Indexed: 08/04/2024] Open
Abstract
Fabry disease is a rare X-linked lysosomal storage disorder that leads to the accumulation of globotriaosylceramide (Gb3) across various tissues, stemming from a deficiency in alpha-galactosidase A (GLA). This condition is characterized by a spectrum of clinical manifestations that can significantly complicate diagnosis. Classical symptoms typically include neuropathic pain, angiokeratomas, and significant involvement of the renal and cardiac systems. However, atypical presentations may obscure the underlying diagnosis, emphasizing the importance of maintaining a high level of clinical suspicion. This case report details the diagnostic journey of a 24-year-old female who initially presented with nephrotic syndrome, a presentation not commonly associated with Fabry disease. Subsequent genetic testing revealed a pathogenic variant in the GLA gene, confirming Fabry disease and highlighting the critical need for genetic analysis in cases of unexplained renal pathology. This case underscores the variability of Fabry disease presentations and the pivotal role of comprehensive diagnostic strategies in uncovering this complex disorder.
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Affiliation(s)
- Manasi Harale
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to be University), Pune, IND
| | - Arun B Oommen
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to be University), Pune, IND
| | - Mayank Mundada
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to be University), Pune, IND
| | - Ahsan A Faruqi
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to be University), Pune, IND
| | - Shivraj Patil
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to be University), Pune, IND
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14
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Kisa PT, Hismi BO, Kocabey M, Gulten ZA, Huddam B, Ekinci S, Bozkaya E, Akar H, Pekuz OKK, Aydogan A, Arslan N. Experience with cascade screening: A comprehensive family pedigree analysis of two index patients with Fabry disease. Am J Med Genet A 2024; 194:e63552. [PMID: 38372211 DOI: 10.1002/ajmg.a.63552] [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: 08/20/2023] [Revised: 01/06/2024] [Accepted: 01/15/2024] [Indexed: 02/20/2024]
Abstract
The wide range of clinical symptoms observed in patients with Fabry disease (FD) often leads to delays in diagnosis and initiation of treatment. Delayed initiation of therapy may result in end-organ damage, such as chronic renal failure, hypertrophic cardiomyopathy, and stroke. Although some tools are available to identify undiagnosed patients, new comprehensive screening methods are needed. In this study, the outcomes of the cascade screening applied to three index cases with FD from 2 familes were investigated. In the pedigree analysis, 280 individuals were included; out of them, 131 individuals underwent genetic testing and cascade screening for FD. During the screening program, a total of 45 individuals were diagnosed, with a diagnostic ratio of 1:15. The average age at diagnosis for all individuals was 30.9 ± 17.7 years, and %25 were pediatric cases (mean age 9.5 ± 5.9 years). Thirty affected relatives were diagnosed from the two index cases in Family 1 and 15 individuals were diagnosed from one index case in Family 2. There were 13 consanguineous marriages observed among 2 pedigres, in two both spouses were affected, leading to two homozygous affected daughters in one couple. In regions where there is a high prevalence of consanguineous marriages, implementing the cascade screening approach to identify all individuals at risk can be beneficial for patients with FD, specifically women and children.
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Affiliation(s)
- Pelin Teke Kisa
- Department of Pediatrics, Division of Inherited Metabolic Diseases, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Burcu Ozturk Hismi
- Department of Pediatrics, Division of Inherited Metabolic Diseases, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Kocabey
- Department of Medical Genetics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Zumrut Arslan Gulten
- Department of Pediatrics, Division of Inherited Metabolic Diseases, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Bulent Huddam
- Department of Nephrology, Department of Internal Medicine, Mugla Sitki Kocman University, Faculty of Medicine, Mugla, Turkey
| | - Selim Ekinci
- Department of Cardiology, Health Sciences University Izmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Evrim Bozkaya
- Department of Nephrology, Denizli State Hospital, Denizli, Turkey
| | - Harun Akar
- Department of Internal Medicine, Health Sciences University Izmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Ozge K Karalar Pekuz
- Department of Pediatrics, Division of Inherited Metabolic Diseases, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Ayca Aydogan
- Department of Pediatrics, Division of Inherited Metabolic Diseases, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Nur Arslan
- Department of Pediatrics, Division of Inherited Metabolic Diseases, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
- Izmir Biomedicine and Genome Center, Izmir, Turkey
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15
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Cuenca-Gómez JÁ, Lara-Rojas CM, Bonilla-López A. Cardiac manifestations in inherited metabolic diseases. Curr Probl Cardiol 2024; 49:102587. [PMID: 38653442 DOI: 10.1016/j.cpcardiol.2024.102587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 04/20/2024] [Indexed: 04/25/2024]
Abstract
Inherited metabolic diseases (IMD) are caused by the functional defect of an enzyme, of genetic origin, that provokes a blockage in a specific metabolic pathway. Individually, IMD are considered rare diseases, with an incidence of less than 1/100,000 births. The symptoms are usually multisystemic, but frequently include cardiac manifestations. Of these, the most common are cardiomyopathies, especially hypertrophic cardiomyopathy. In addition, they can cause dilated or restrictive cardiomyopathy and non-compacted cardiomyopathy of the left ventricle. Characteristic signs also include rhythm alterations (atrio-ventricular conduction disturbances, Wolff-Parkinson-White syndrome or ventricular arrhythmias), valvular pathology and ischaemic coronary pathologies. The aim of this study is to present a narrative review of the IMD that may produce cardiac involvement. We describe both the specific cardiac manifestations of each disease and the systemic symptoms that guide diagnosis.
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Affiliation(s)
- José Ángel Cuenca-Gómez
- Internal Medicine Service Hospital de Poniente El Ejido, Almería, Spain; Working Group on Minority Diseases of the Spanish Society of Internal Medicine (GTEM-SEMI), Almería, Spain.
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16
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Figliozzi S, Kollia E, Simistiras A, Camporeale A, Stankowski K, Masci PG, Mavraganis G, Lombardi M, Condorelli G, Francone M, Pieroni M, Georgiopoulos G. Effects of Enzyme Replacement Therapy on Cardiac MRI Findings in Fabry Disease: A Systematic Review and Meta-Analysis. Radiol Cardiothorac Imaging 2024; 6:e230154. [PMID: 38842453 PMCID: PMC11211942 DOI: 10.1148/ryct.230154] [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: 06/09/2023] [Revised: 04/03/2024] [Accepted: 04/24/2024] [Indexed: 06/07/2024]
Abstract
Purpose To perform a systematic review and meta-analysis to assess the effect of enzyme replacement therapy on cardiac MRI parameters in patients with Fabry disease. Materials and Methods A systematic literature search was conducted from January 1, 2000, through January 1, 2024, in PubMed, ClinicalTrials.gov, Embase, and Cochrane Library databases. Study outcomes were changes in the following parameters: (a) left ventricular wall mass (LVM), measured in grams; (b) LVM indexed to body mass index, measured in grams per meters squared; (c) maximum left ventricular wall thickness (MLVWT), measured in millimeters; (d) late gadolinium enhancement (LGE) extent, measured in percentage of LVM; and (e) native T1 mapping, measured in milliseconds. A random-effects meta-analysis of the pooled mean differences between baseline and follow-up parameters was conducted. The study protocol was registered in PROSPERO (CRD42022336223). Results The final analysis included 11 studies of a total of 445 patients with Fabry disease (mean age ± SD, 41 years ± 11; 277 male, 168 female). Between baseline and follow-up cardiac MRI, the following did not change: T1 mapping (mean difference, 6 msec [95% CI: -2, 15]; two studies, 70 patients, I2 = 88%) and LVM indexed (mean difference, -1 g/m2 [95% CI: -6, 3]; four studies, 290 patients, I2 = 81%). The following measures minimally decreased: LVM (mean difference, -18 g [95% CI: -33, -3]; seven studies, 107 patients, I2 = 96%) and MLVWT (mean difference, -1 mm [95% CI: -2, -0.02]; six studies, 151 patients, I2 = 90%). LGE extent increased (mean difference, 1% [95% CI: 1, 1]; three studies, 114 patients, I2 = 85%). Conclusion In patients with Fabry disease, enzyme replacement therapy was associated with stabilization of LVM, MLVWT, and T1 mapping values, whereas LGE extent mildly increased. Keywords: Fabry Disease, Enzyme Replacement Therapy (ERT), Cardiac MRI, Late Gadolinium Enhancement (LGE) Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
| | | | - Alexandros Simistiras
- From the Cardio Center, IRCCS Humanitas Research Hospital, Via
Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy (S.F., G.C., M.F.); Emergency
Department, Hippokrateio General Hospital of Athens, Athens, Greece (E.K.);
Institute for Bioinnovation, BSRC Alexander Fleming, Vari, Greece (A.S.);
Multimodality Imaging Section, IRCCS Policlinico San Donato, San Donato
Milanese, Milan, Italy (A.C., M.L., G.C., M.F.); Hunimed, Humanitas University,
Pieve Emanuele, Milan, Italy (K.S.); King's College London, London,
United Kingdom (P.G.M.); National and Kapodistrian University of Athens, Athens,
Greece (G.M., G.G.); and San Donato Hospital, Arezzo, Italy (M.P.)
| | - Antonia Camporeale
- From the Cardio Center, IRCCS Humanitas Research Hospital, Via
Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy (S.F., G.C., M.F.); Emergency
Department, Hippokrateio General Hospital of Athens, Athens, Greece (E.K.);
Institute for Bioinnovation, BSRC Alexander Fleming, Vari, Greece (A.S.);
Multimodality Imaging Section, IRCCS Policlinico San Donato, San Donato
Milanese, Milan, Italy (A.C., M.L., G.C., M.F.); Hunimed, Humanitas University,
Pieve Emanuele, Milan, Italy (K.S.); King's College London, London,
United Kingdom (P.G.M.); National and Kapodistrian University of Athens, Athens,
Greece (G.M., G.G.); and San Donato Hospital, Arezzo, Italy (M.P.)
| | - Kamil Stankowski
- From the Cardio Center, IRCCS Humanitas Research Hospital, Via
Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy (S.F., G.C., M.F.); Emergency
Department, Hippokrateio General Hospital of Athens, Athens, Greece (E.K.);
Institute for Bioinnovation, BSRC Alexander Fleming, Vari, Greece (A.S.);
Multimodality Imaging Section, IRCCS Policlinico San Donato, San Donato
Milanese, Milan, Italy (A.C., M.L., G.C., M.F.); Hunimed, Humanitas University,
Pieve Emanuele, Milan, Italy (K.S.); King's College London, London,
United Kingdom (P.G.M.); National and Kapodistrian University of Athens, Athens,
Greece (G.M., G.G.); and San Donato Hospital, Arezzo, Italy (M.P.)
| | - Pier Giorgio Masci
- From the Cardio Center, IRCCS Humanitas Research Hospital, Via
Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy (S.F., G.C., M.F.); Emergency
Department, Hippokrateio General Hospital of Athens, Athens, Greece (E.K.);
Institute for Bioinnovation, BSRC Alexander Fleming, Vari, Greece (A.S.);
Multimodality Imaging Section, IRCCS Policlinico San Donato, San Donato
Milanese, Milan, Italy (A.C., M.L., G.C., M.F.); Hunimed, Humanitas University,
Pieve Emanuele, Milan, Italy (K.S.); King's College London, London,
United Kingdom (P.G.M.); National and Kapodistrian University of Athens, Athens,
Greece (G.M., G.G.); and San Donato Hospital, Arezzo, Italy (M.P.)
| | - George Mavraganis
- From the Cardio Center, IRCCS Humanitas Research Hospital, Via
Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy (S.F., G.C., M.F.); Emergency
Department, Hippokrateio General Hospital of Athens, Athens, Greece (E.K.);
Institute for Bioinnovation, BSRC Alexander Fleming, Vari, Greece (A.S.);
Multimodality Imaging Section, IRCCS Policlinico San Donato, San Donato
Milanese, Milan, Italy (A.C., M.L., G.C., M.F.); Hunimed, Humanitas University,
Pieve Emanuele, Milan, Italy (K.S.); King's College London, London,
United Kingdom (P.G.M.); National and Kapodistrian University of Athens, Athens,
Greece (G.M., G.G.); and San Donato Hospital, Arezzo, Italy (M.P.)
| | - Massimo Lombardi
- From the Cardio Center, IRCCS Humanitas Research Hospital, Via
Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy (S.F., G.C., M.F.); Emergency
Department, Hippokrateio General Hospital of Athens, Athens, Greece (E.K.);
Institute for Bioinnovation, BSRC Alexander Fleming, Vari, Greece (A.S.);
Multimodality Imaging Section, IRCCS Policlinico San Donato, San Donato
Milanese, Milan, Italy (A.C., M.L., G.C., M.F.); Hunimed, Humanitas University,
Pieve Emanuele, Milan, Italy (K.S.); King's College London, London,
United Kingdom (P.G.M.); National and Kapodistrian University of Athens, Athens,
Greece (G.M., G.G.); and San Donato Hospital, Arezzo, Italy (M.P.)
| | - Gianluigi Condorelli
- From the Cardio Center, IRCCS Humanitas Research Hospital, Via
Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy (S.F., G.C., M.F.); Emergency
Department, Hippokrateio General Hospital of Athens, Athens, Greece (E.K.);
Institute for Bioinnovation, BSRC Alexander Fleming, Vari, Greece (A.S.);
Multimodality Imaging Section, IRCCS Policlinico San Donato, San Donato
Milanese, Milan, Italy (A.C., M.L., G.C., M.F.); Hunimed, Humanitas University,
Pieve Emanuele, Milan, Italy (K.S.); King's College London, London,
United Kingdom (P.G.M.); National and Kapodistrian University of Athens, Athens,
Greece (G.M., G.G.); and San Donato Hospital, Arezzo, Italy (M.P.)
| | - Marco Francone
- From the Cardio Center, IRCCS Humanitas Research Hospital, Via
Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy (S.F., G.C., M.F.); Emergency
Department, Hippokrateio General Hospital of Athens, Athens, Greece (E.K.);
Institute for Bioinnovation, BSRC Alexander Fleming, Vari, Greece (A.S.);
Multimodality Imaging Section, IRCCS Policlinico San Donato, San Donato
Milanese, Milan, Italy (A.C., M.L., G.C., M.F.); Hunimed, Humanitas University,
Pieve Emanuele, Milan, Italy (K.S.); King's College London, London,
United Kingdom (P.G.M.); National and Kapodistrian University of Athens, Athens,
Greece (G.M., G.G.); and San Donato Hospital, Arezzo, Italy (M.P.)
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17
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Nicholls K, Denaro C, Tchan M, Ellaway C, Bratkovic D, Campbell S, Fookes M, Thomas M. Fabry-specific treatment in Australia: time to align eligibility criteria with international best practices. Intern Med J 2024; 54:882-890. [PMID: 38212950 DOI: 10.1111/imj.16327] [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: 08/25/2023] [Accepted: 12/20/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Disease-specific therapy aims to improve symptoms, stabilise current disease and delay progression in patients with Fabry disease. In Australia, treatment access is subject to eligibility criteria initially established in 2004. Patients and their clinicians question why these criteria have remained unchanged despite significant progress in disease understanding. AIMS Appraise the clinical quality of the Australian treatment access criteria. METHODS The Fabry Australia Medical Advisory Committee (N = 6) used the Appraisal of Guidelines for REsearch and Evaluation Global Rating Scale (AGREE II GRS) to assess the clinical quality of the current treatment eligibility criteria. They reviewed the literature, developed 17 clinical statements to help guide reforms of the eligibility criteria and achieved consensus (achievement of ≥75% agreement in the range 5-7 on a 7-point Likert scale) through anonymous voting. The findings were applied to develop proposals for revised classification and treatment initiation criteria. RESULTS The current treatment eligibility criteria underperformed on the AGREE II GRS. They are pragmatic but out-of-step with contemporary data. Consensus was achieved on all 17 proposed clinical statements. There was strong agreement to differentiate classical male Fabry patients to facilitate timelier access to Fabry-specific treatment. There was also agreement on the value of adopting relevant organ involvement criteria in classical female patients and patients with non-classical disease. CONCLUSIONS Australian access criteria are misaligned with current clinical evidence. The clinical statements and proposed classification and initiation criteria should prompt discussions to support more equitable access to treatment and better align Australian practice with contemporary evidence and international guidelines.
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Affiliation(s)
- Kathleen Nicholls
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Charles Denaro
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Academy of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Michel Tchan
- Department of Genetic Medicine, Westmead Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Carolyn Ellaway
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Genetic Metabolic Disorders Service, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| | - Drago Bratkovic
- Department of Internal Medicine and Aged Care, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | | | - Megan Fookes
- Fabry Australia, Sydney, New South Wales, Australia
| | - Mark Thomas
- Department of Nephrology, Royal Perth Hospital, Perth, Western Australia, Australia
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18
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Dupré N, Drieu A, Joutel A. Pathophysiology of cerebral small vessel disease: a journey through recent discoveries. J Clin Invest 2024; 134:e172841. [PMID: 38747292 PMCID: PMC11093606 DOI: 10.1172/jci172841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024] Open
Abstract
Cerebral small vessel disease (cSVD) encompasses a heterogeneous group of age-related small vessel pathologies that affect multiple regions. Disease manifestations range from lesions incidentally detected on neuroimaging (white matter hyperintensities, small deep infarcts, microbleeds, or enlarged perivascular spaces) to severe disability and cognitive impairment. cSVD accounts for approximately 25% of ischemic strokes and the vast majority of spontaneous intracerebral hemorrhage and is also the most important vascular contributor to dementia. Despite its high prevalence and potentially long therapeutic window, there are still no mechanism-based treatments. Here, we provide an overview of the recent advances in this field. We summarize recent data highlighting the remarkable continuum between monogenic and multifactorial cSVDs involving NOTCH3, HTRA1, and COL4A1/A2 genes. Taking a vessel-centric view, we discuss possible cause-and-effect relationships between risk factors, structural and functional vessel changes, and disease manifestations, underscoring some major knowledge gaps. Although endothelial dysfunction is rightly considered a central feature of cSVD, the contributions of smooth muscle cells, pericytes, and other perivascular cells warrant continued investigation.
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Affiliation(s)
- Nicolas Dupré
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France
| | - Antoine Drieu
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France
| | - Anne Joutel
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France
- GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
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19
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Hotta J, Jogu Y, Bamba H, Izumiya Y, Kudo M, Imai T, Sakuraba H, Hamazaki T, Seto T. Potential Usefulness of Lifetime Globotriaosylsphingosine Exposure at Diagnosis and Baseline Modified Disease Severity Score in Early-Diagnosed Patients With Fabry Disease. Cureus 2024; 16:e61380. [PMID: 38947680 PMCID: PMC11214581 DOI: 10.7759/cureus.61380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND Fabry disease (FD) is a lysosomal storage disease caused by a deficit of α-galactosidase A (GAL). Recently, plasma globotriaosylsphingosine (lyso-Gb3), a pathogenic analog of a substrate of GAL, has been suggested as a potential biomarker for FD, and disease severity scores, such as the Mainz Severity Score Index (MSSI), the Disease Severity Scoring System (DS3), and FASTEX (FAbry STabilization indEX), are useful tools for evaluating the severity of signs and symptoms in symptomatic FD patients. However, a more useful method of evaluating disease severity in early-diagnosed FD patients such as children, adult females, and asymptomatic patients is needed. Here, we proposed modified MSSI and DS3 scores to which we added phenotype, urinary mulberry bodies, and history of past pain attacks and examined the clinical usefulness of lyso-Gb3 and modified scores for early-diagnosed FD patients. RESULT In 13 early-diagnosed FD patients, we developed modified MSSI and DS3 scores and examined the correlation of lifetime lyso-Gb3 exposure at diagnosis with the conventional or modified scores. Lifetime lyso-Gb3 exposure was positively correlated only with the modified DS3 score. Additionally, we examined the long-term changes in plasma lyso-Gb3 concentration and in conventional MSSI, DS3, and FASTEX. In males, plasma lyso-Gb3 concentration decreased more rapidly than in females. In all patients, the severity scores were mild and remained nearly stable throughout the follow-up period. CONCLUSION Our data suggest that lifetime lyso-Gb3 exposure and the modified DS3 score are useful in early-diagnosed patients.
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Affiliation(s)
- Junko Hotta
- Department of Medical Genetics, Osaka Metropolitan University Graduate School of Medicine, Osaka, JPN
- Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, JPN
| | - Yukiko Jogu
- Department of Medical Genetics, Osaka Metropolitan University Graduate School of Medicine, Osaka, JPN
| | - Haruka Bamba
- Department of Medical Genetics, Osaka Metropolitan University Graduate School of Medicine, Osaka, JPN
| | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, JPN
| | - Masaharu Kudo
- Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine, Osaka, JPN
| | - Takumi Imai
- Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine, Osaka, JPN
| | - Hitoshi Sakuraba
- Department of Clinical Genetics, Meiji Pharmaceutical University, Tokyo, JPN
| | - Takashi Hamazaki
- Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, JPN
| | - Toshiyuki Seto
- Department of Medical Genetics, Osaka Metropolitan University Graduate School of Medicine, Osaka, JPN
- Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, JPN
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20
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Feriozzi S, Chimenti C, Reisin RC. Updated Evaluation of Agalsidase Alfa Enzyme Replacement Therapy for Patients with Fabry Disease: Insights from Real-World Data. Drug Des Devel Ther 2024; 18:1083-1101. [PMID: 38585254 PMCID: PMC10999212 DOI: 10.2147/dddt.s365885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/27/2024] [Indexed: 04/09/2024] Open
Abstract
The clinical use of agalsidase alfa as enzyme replacement therapy (ERT) for Fabry disease (FD) has spread since 2001, and a large body of evidence of its effectiveness has been collected. This review presents the clinical and laboratory results achieved with agalsidase alfa, which has been published in the literature. Agalsidase alfa infusion slows down or stops the progression of renal damage, expressed by reduction or stabilization of the annual decline of the glomerular filtration rate; yearly decrease of glomerular filtration rate (slope) sometimes is reduced until its stabilization. ERT prevents or reduces the occurrence of hypertrophic cardiomyopathy or slows the increase over time if it is already present. Moreover, regarding neurological manifestations, ERT improves neuropathic pain and quality of life, and recent data indicated that it may also prevent the burden of cerebrovascular disease. In addition to ERT's clinical benefits, crucial topics like the most appropriate time to start therapy and the role of anti-drug antibodies (ADA) are analyzed. Treatment with agalsidase alfa in patients with FD substantially improves their outcomes and enhances their quality of life in patients with FD.
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Affiliation(s)
- Sandro Feriozzi
- Department of Nephrology and Dialysis Unit, Belcolle Hospital Viterbo, Italy
| | - Cristina Chimenti
- Department of Clinical Sciences, Internal Medicine, Anesthesiology and Cardiovascular Sciences, La Sapienza University, Rome, Italy
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21
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Drapkina OM, Kontsevaya AV, Kalinina AM, Avdeev SN, Agaltsov MV, Alekseeva LI, Almazova II, Andreenko EY, Antipushina DN, Balanova YA, Berns SA, Budnevsky AV, Gainitdinova VV, Garanin AA, Gorbunov VM, Gorshkov AY, Grigorenko EA, Jonova BY, Drozdova LY, Druk IV, Eliashevich SO, Eliseev MS, Zharylkasynova GZ, Zabrovskaya SA, Imaeva AE, Kamilova UK, Kaprin AD, Kobalava ZD, Korsunsky DV, Kulikova OV, Kurekhyan AS, Kutishenko NP, Lavrenova EA, Lopatina MV, Lukina YV, Lukyanov MM, Lyusina EO, Mamedov MN, Mardanov BU, Mareev YV, Martsevich SY, Mitkovskaya NP, Myasnikov RP, Nebieridze DV, Orlov SA, Pereverzeva KG, Popovkina OE, Potievskaya VI, Skripnikova IA, Smirnova MI, Sooronbaev TM, Toroptsova NV, Khailova ZV, Khoronenko VE, Chashchin MG, Chernik TA, Shalnova SA, Shapovalova MM, Shepel RN, Sheptulina AF, Shishkova VN, Yuldashova RU, Yavelov IS, Yakushin SS. Comorbidity of patients with noncommunicable diseases in general practice. Eurasian guidelines. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2024; 23:3696. [DOI: 10.15829/1728-8800-2024-3996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2024] Open
Abstract
Создание руководства поддержано Советом по терапевтическим наукам отделения клинической медицины Российской академии наук.
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22
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Del Franco A, Iannaccone G, Meucci MC, Lillo R, Cappelli F, Zocchi C, Pieroni M, Graziani F, Olivotto I. Clinical staging of Anderson-Fabry cardiomyopathy: An operative proposal. Heart Fail Rev 2024; 29:431-444. [PMID: 38006470 DOI: 10.1007/s10741-023-10370-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 11/27/2023]
Abstract
As a slowly progressive form of hypertrophic cardiomyopathy (HCM), Anderson-Fabry disease (FD) resembles the phenotype of the most common sarcomeric forms, although significant differences in presentation and long-term progression may help determine the correct diagnosis. A variety of electrocardiographic and imaging features of FD cardiomyopathy have been described at different times in the course of the disease, and considerable discrepancies remain regarding the assessment of disease severity by individual physicians. Therefore, we here propose a practical staging of FD cardiomyopathy, in hopes it may represent the standard for cardiac evaluation and facilitate communication between specialized FD centres and primary care physicians. We identified 4 main stages of FD cardiomyopathy of increasing severity, based on available evidence from clinical and imaging studies: non-hypertrophic, hypertrophic - pre-fibrotic, hypertrophic - fibrotic, and overt dysfunction. Each stage is described and discussed in detail, following the principle that speaking a common language is critical when managing such complex patients in a multi-disciplinary and sometimes multi-centre setting.
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Affiliation(s)
| | - Giulia Iannaccone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Chiara Meucci
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosa Lillo
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Cappelli
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Chiara Zocchi
- Cardiovascular Department, San Donato Hospital, Arezzo, Italy
| | | | - Francesca Graziani
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Iacopo Olivotto
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Cardiology Unit, Meyer University Hospital, Florence, Italy
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23
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Romani I, Sarti C, Nencini P, Pracucci G, Zedde M, Cianci V, Nucera A, Moller J, Orsucci D, Toni D, Palumbo P, Casella C, Pinto V, Barbarini L, Bella R, Scoditti U, Ragno M, Mezzapesa DM, Tassi R, Volpi G, Diomedi M, Bigliardi G, Cavallini AM, Chiti A, Ricci S, Cecconi E, Linoli G, Sacco S, Rasura M, Giordano A, Bonetti B, Melis M, Cariddi LP, Dossi RC, Grisendi I, Aguglia U, Di Ruzza MR, Melis M, Sbardella E, Vista M, Valenti R, Musolino RF, Passarella B, Direnzo V, Pennisi G, Genovese A, Di Marzio F, Sgobio R, Acampa M, Nannucci S, Dagostino F, Dell'Acqua ML, Cuzzoni MG, Picchioni A, Calchetti B, Notturno F, Di Lisi F, Forlivesi S, Delodovici ML, Buechner SC, Biagini S, Accavone D, Manna R, Morrone A, Inzitari D. Prevalence of Fabry disease and GLA variants in young patients with acute stroke: The challenge to widen the screening. The Fabry-Stroke Italian Registry. J Neurol Sci 2024; 457:122905. [PMID: 38295534 DOI: 10.1016/j.jns.2024.122905] [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: 09/12/2023] [Revised: 12/10/2023] [Accepted: 01/22/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Fabry disease (FD) is a treatable X-linked lysosomal storage disorder caused by GLA gene variants leading to alpha-galactosidase A deficiency. FD is a rare cause of stroke, and it is still controversial whether in stroke patients FD should be searched from the beginning or at the end of the diagnostic workup (in cryptogenic strokes). METHODS Fabry-Stroke Italian Registry is a prospective, multicentric screening involving 33 stroke units. FD was sought by measuring α-galactosidase A activity (males) and by genetic tests (males with reduced enzyme activity and females) in patients aged 18-60 years hospitalized for TIA, ischemic stroke, or intracerebral hemorrhage. We diagnosed FD in patients with 1) already known pathogenic GLA variants; 2) novel GLA variants if additional clinical, laboratory, or family-derived criteria were present. RESULTS Out of 1906 patients, we found a GLA variant in 15 (0.79%; 95%CI 0.44-1.29) with a certain FD diagnosis in 3 (0.16%; 95%CI 0.03-0.46) patients, none of whom had hemorrhage. We identified 1 novel pathogenic GLA variant. Ischemic stroke etiologies in carriers of GLA variants were: cardioaortic embolism (33%), small artery occlusion (27%), other causes (20%), and undetermined (20%). Mild severity, recurrence, previous TIA, acroparesthesias, hearing loss, and small artery occlusion were predictors of GLA variant. CONCLUSION In this large multicenter cohort the frequency of FD and GLA variants was consistent with previous reports. Limiting the screening for GLA variants to patients with cryptogenic stroke may miss up to 80% of diagnoses. Some easily recognizable clinical features could help select patients for FD screening.
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Affiliation(s)
- Ilaria Romani
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Italy
| | - Cristina Sarti
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Italy; Stroke Unit, Careggi University Hospital, Florence, Italy.
| | - Patrizia Nencini
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Italy; Stroke Unit, Careggi University Hospital, Florence, Italy
| | - Giovanni Pracucci
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Italy
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Vittoria Cianci
- Neurology, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Antonia Nucera
- Stroke Unit - Neurology, Spaziani Hospital, Frosinone, Italy
| | | | | | - Danilo Toni
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; Emergency Department Stroke Unit, Umberto I Polyclinic Hospital, Rome, Italy
| | - Pasquale Palumbo
- Neurology, Neurophysiopathology, and Stroke Unit, Santo Stefano Hospital, Prato, Italy
| | - Carmela Casella
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vincenza Pinto
- Neurology and Stroke Unit, Di Summa - Perrino Hospital, Brindisi, Italy
| | | | - Rita Bella
- Acute Cerebrovascular Diseases Unit, G. Rodoloco-San Marco Polyclinic University Hospital, Catania, Italy; Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Italy
| | - Umberto Scoditti
- Neurology - Stroke Care Program, Parma University Hospital, Parma, Italy
| | - Michele Ragno
- Division of Neurology, ASUR Marche AV5, Ascoli Piceno-San Benedetto del Tronto, Italy
| | | | - Rossana Tassi
- Neurosonology and Stroke Unit, Siena University Hospital, Siena, Italy
| | - Gino Volpi
- Neurology, San Iacopo Hospital, Pistoia, Italy
| | - Marina Diomedi
- Comprehensive Stroke Center, Department of Neuroscience, University of Tor Vergata, Rome, Italy; Neurovascular Treatment Unit, Tor Vergata Polyclinic Hospital, Rome, Italy
| | - Guido Bigliardi
- Stroke Unit, Neurology Clinic, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Italy
| | - Anna Maria Cavallini
- Department of Cerebrovascular Disease and Stroke Unit, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Stefano Ricci
- Stroke Center - Neurology, Città Di Castello Hospital, Perugia, Italy; Stroke Center - Neurology, Gubbio-Gualdo Tadino Hospital, Perugia, Italy
| | | | | | - Simona Sacco
- Neurology and Stroke Unit, SS. Filippo e Nicola Hospital, Avezzano, Italy; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Maurizia Rasura
- Stroke Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Bruno Bonetti
- Stroke Unit, Verona University Hospital, Verona, Italy
| | - Marta Melis
- Neurology, Monserrato University Hospital, Cagliari, Italy
| | | | | | - Ilaria Grisendi
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | | | - Emilia Sbardella
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Raffaella Valenti
- Neurology, Neurophysiopathology, and Stroke Unit, Santo Stefano Hospital, Prato, Italy
| | | | - Bruno Passarella
- Neurology and Stroke Unit, Di Summa - Perrino Hospital, Brindisi, Italy
| | | | - Giovanni Pennisi
- Acute Cerebrovascular Diseases Unit, G. Rodoloco-San Marco Polyclinic University Hospital, Catania, Italy; Department of Biomedical and Biotechnological Science, University of Catania, Catania, Italy
| | - Antonio Genovese
- Neurology - Stroke Care Program, Parma University Hospital, Parma, Italy
| | - Fabio Di Marzio
- Division of Neurology, ASUR Marche AV5, Ascoli Piceno-San Benedetto del Tronto, Italy
| | - Rossana Sgobio
- University Neurology, Bari Polyclinic Hospital, Bari, Italy
| | - Maurizio Acampa
- Neurosonology and Stroke Unit, Siena University Hospital, Siena, Italy
| | | | - Federica Dagostino
- Neurovascular Treatment Unit, Tor Vergata Polyclinic Hospital, Rome, Italy
| | - Maria Luisa Dell'Acqua
- Stroke Unit, Neurology Clinic, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Italy
| | - Maria Giovanna Cuzzoni
- Department of Cerebrovascular Disease and Stroke Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Antonella Picchioni
- Stroke Center - Neurology, Città Di Castello Hospital, Perugia, Italy; Stroke Center - Neurology, Gubbio-Gualdo Tadino Hospital, Perugia, Italy
| | | | - Francesca Notturno
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Filomena Di Lisi
- Stroke Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | | | | | - Silvia Biagini
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Italy
| | - Donatella Accavone
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Italy
| | - Raffaele Manna
- Department of Internal Medicine, Gemelli University Hospital, Rome, Italy; Rare Diseases and Periodic Fevers Research Centre, Catholic University of the Sacred Heart, Rome, Italy
| | - Amelia Morrone
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Italy; Laboratory of Molecular Biology of Neurometabolic Diseases, Neuroscience Department, Meyer Children's Hospital, Florence, Italy
| | - Domenico Inzitari
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Italy; Stroke Unit, Careggi University Hospital, Florence, Italy
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24
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Gambardella J, Riccio E, Bianco A, Fiordelisi A, Cerasuolo FA, Buonaiuto A, Di Risi T, Viti A, Avvisato R, Pisani A, Sorriento D, Iaccarino G. Fatigue as hallmark of Fabry disease: role of bioenergetic alterations. Front Cardiovasc Med 2024; 11:1341590. [PMID: 38327490 PMCID: PMC10847249 DOI: 10.3389/fcvm.2024.1341590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/09/2024] [Indexed: 02/09/2024] Open
Abstract
Fabry disease (FD) is a lysosomal storage disorder due to the impaired activity of the α-galactosidase A (GLA) enzyme which induces Gb3 deposition and multiorgan dysfunction. Exercise intolerance and fatigue are frequent and early findings in FD patients, representing a self-standing clinical phenotype with a significant impact on the patient's quality of life. Several determinants can trigger fatigability in Fabry patients, including psychological factors, cardiopulmonary dysfunctions, and primary alterations of skeletal muscle. The "metabolic hypothesis" to explain skeletal muscle symptoms and fatigability in Fabry patients is growing acknowledged. In this report, we will focus on the primary alterations of the motor system emphasizing the role of skeletal muscle metabolic disarrangement in determining the altered exercise tolerance in Fabry patients. We will discuss the most recent findings about the metabolic profile associated with Fabry disease offering new insights for diagnosis, management, and therapy.
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Affiliation(s)
- Jessica Gambardella
- Centro Interdipartimentale di Ricerca in Ipertensione Arteriosa e Patologie Associate, Federico II University of Naples, Naples, Italy
- Federico II University Hospital, Naples, Italy
| | - Eleonora Riccio
- Centro Interdipartimentale di Ricerca in Ipertensione Arteriosa e Patologie Associate, Federico II University of Naples, Naples, Italy
| | | | | | | | | | | | | | | | - Antonio Pisani
- Centro Interdipartimentale di Ricerca in Ipertensione Arteriosa e Patologie Associate, Federico II University of Naples, Naples, Italy
- Federico II University Hospital, Naples, Italy
| | - Daniela Sorriento
- Centro Interdipartimentale di Ricerca in Ipertensione Arteriosa e Patologie Associate, Federico II University of Naples, Naples, Italy
- Federico II University Hospital, Naples, Italy
| | - Guido Iaccarino
- Centro Interdipartimentale di Ricerca in Ipertensione Arteriosa e Patologie Associate, Federico II University of Naples, Naples, Italy
- Federico II University Hospital, Naples, Italy
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Yang A, Kim S, Choi YJ. Impact of Nontreatment Duration and Keratopathy on Major Adverse Cardiovascular Events in Fabry Disease: A Nationwide Cohort Study. J Clin Med 2024; 13:479. [PMID: 38256613 PMCID: PMC10817061 DOI: 10.3390/jcm13020479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/11/2024] [Accepted: 01/14/2024] [Indexed: 01/24/2024] Open
Abstract
Fabry disease (FD) is a rare inherited X-linked lysosomal storage disorder that results in the progressive accumulation of glycosphingolipids in multiple organs. Early FD-specific treatments may improve clinical outcomes; however, clinical evidence about early FD treatment is limited. We aimed to determine the cardiovascular outcomes of patients with FD who received enzyme replacement therapy. This nationwide observational study was conducted using the National Health Claims database of the Korean population with FD. The primary outcome was major adverse cardiovascular events (MACEs). MACE risk factors in FD were evaluated using time-dependent Cox regression. Between January 2007 and April 2022, 188 patients with FD were analyzed. Among them, 22 (11.7%) experienced MACE (males: 14/95 [14.7%]; females: 8/93 [8.6%]). The mean age at MACE diagnosis was 53.5 ± 11.0 years in all patients with FD, which was lower in males compared with in females (49.7 ± 9.6 vs. 60.0 ± 10.7 years, p = 0.030). Multivariate analysis (HR, 95% CI) revealed that age (1.042; 1.004-1.082) and duration of FD nontreatment (1.040; 1.003-1.078) were significant MACE risk factors in all patients. In males, age (1.080; 1.032-1.131), FD nontreatment duration (1.099; 1.048-1.152), and keratopathy (18.920; 4.174-85.749) were significant MACE risk factors in multivariate analysis. In females, the only significant MACE risk factor was a high Charlson comorbidity index score (1.795; 1.229-2.622). In conclusion, duration of FD nontreatment and keratopathy are significant MACE risk factors in males with FD. These findings suggest the importance of early initiation of FD-specific treatment and careful evaluation of keratopathy in males with FD.
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Affiliation(s)
- Aram Yang
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea;
| | - Sinae Kim
- Biostatistics Collaboration Team, Research Core Center, National Cancer Center, Goyang 10408, Republic of Korea;
| | - Yong Jun Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 04763, Republic of Korea
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D'Amore S, Mckie M, Fahey A, Bleloch D, Grillo G, Hughes M, Ramaswami U. Fabry App: the value of a portable technology in recording day-to-day patient monitored information in patients with Fabry disease. Orphanet J Rare Dis 2024; 19:13. [PMID: 38212814 PMCID: PMC11057153 DOI: 10.1186/s13023-023-02999-6] [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: 06/28/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Fabry disease is a rare inherited disorder resulting from deficient α-galactosidase A enzyme activity. Common disease manifestations are sweating abnormalities, neuropathic pain, gastrointestinal symptoms and fatigue. Challenges are faced by health care professionals in evaluating symptom burden in the current clinical setting, and the demand for alternative methods for monitoring disease-specific symptoms has seen an acceleration in recent years. Smartphone technologies offer the potential for continuity of care and surveillance. As a part of a quality improvement project, a disease specific app was developed in collaboration with a software company (Health Touch Ltd) and made available for patient use in May 2018. The Fabry mobile app records five categories: pain, gastrointestinal symptoms, sweating, activity levels, medications. Fabry disease patients with gastrointestinal and pain symptoms attending the Lysosomal Storage Disorders Unit of the Royal Free London NHS Foundation Trust were reviewed to assess eligibility and invited to download the app for recording their symptoms (activity, sweating, pain and gastrointestinal) and medications. Patient-generated data were transmitted to a secure website for clinicians to review. RESULTS One-hundred and thirty-nine symptomatic Fabry disease patients who had a smartphone (iPhone or android) were invited to download the app. Sixty-seven patients (26 males and 41 females; median age, 49 years [range, 20-81]) downloaded and tracked the Fabry App at least once. The median frequency of use per patient was 6 (range, 1-629). Pain in the hands and abdominal pain were significantly higher (p = 0.009 and p = 0.007, respectively) in patients with classic phenotype compared with patients with non-classic phenotypes. CONCLUSIONS We demonstrated the feasibility and acceptability of a smartphone app to facilitate the remote assessment and monitoring of Fabry disease symptom burden on a daily/weekly basis, as an alternative to the current standard of care that requires patients to recall their symptoms during 6 to 12 monthly annual clinic visits. Patients who were more likely to use the app had greater disease burden. This innovation has the potential to assess disease progression, early therapeutic intervention, thereby decreasing the burden of morbidity and mortality among Fabry patients, and to record long-term effects of Fabry-specific therapies.
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Affiliation(s)
- Simona D'Amore
- Lysosomal Storage Disorders Unit, Royal Free Hospital NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- Chiesi Farmaceutici S.P.A., Via Paradigna 131/A, 43122, Parma, Italy
| | - Mark Mckie
- Lysosomal Storage Disorders Unit, Royal Free Hospital NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Andrew Fahey
- HealthTouch Ltd, Little Halt, Bull Lane, Chislehurst, Kent, BR7 6NX, UK
| | - David Bleloch
- Lysosomal Storage Disorders Unit, Royal Free Hospital NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Giuseppina Grillo
- Lysosomal Storage Disorders Unit, Royal Free Hospital NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Michael Hughes
- HealthTouch Ltd, Little Halt, Bull Lane, Chislehurst, Kent, BR7 6NX, UK
| | - Uma Ramaswami
- Lysosomal Storage Disorders Unit, Royal Free Hospital NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.
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Mackels L, Servais L. The Importance of Early Treatment of Inherited Neuromuscular Conditions. J Neuromuscul Dis 2024; 11:253-274. [PMID: 38306060 DOI: 10.3233/jnd-230189] [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] [Indexed: 02/03/2024]
Abstract
There has been tremendous progress in treatment of neuromuscular diseases over the last 20 years, which has transformed the natural history of these severely debilitating conditions. Although the factors that determine the response to therapy are many and in some instance remain to be fully elucidated, early treatment clearly has a major impact on patient outcomes across a number of inherited neuromuscular conditions. To improve patient care and outcomes, clinicians should be aware of neuromuscular conditions that require prompt treatment initiation. This review describes data that underscore the importance of early treatment of children with inherited neuromuscular conditions with an emphasis on data resulting from newborn screening efforts.
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Affiliation(s)
- Laurane Mackels
- MDUK Oxford Neuromuscular Centre, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- Adult Neurology Department, Citadelle Hospital, Liège, Belgium
| | - Laurent Servais
- Neuromuscular Centre, Division of Paediatrics, University and University Hospital of Liège, Liège, Belgium
- MDUK Oxford Neuromuscular Centre, Department of Paediatrics, University of Oxford & NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
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Rydzewska-Rosołowska A, Hryszko T. Fabry disease - what a gastroenterologist should know. PRZEGLAD GASTROENTEROLOGICZNY 2023; 18:368-372. [PMID: 38572452 PMCID: PMC10985740 DOI: 10.5114/pg.2023.133516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 04/05/2024]
Abstract
Fabry disease is a rare, X-linked metabolic error caused by various mutations in the α-galactosidase A gene, which results in the accumulation of glycosphingolipids. Gastrointestinal symptoms are quite common in affected patients; therefore, it is important for gastroenterologists to keep it in mind as a differential diagnosis for especially challenging patients. The following review provides concise information on epidemiology and genetics, signs, and symptoms of the disease, focusing on the gastrointestinal (GI) tract, providing a brief overview of the diagnostic process and the available treatment, both disease specific and supportive, again with a focus on alleviation of gastrointestinal symptoms.
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Affiliation(s)
- Alicja Rydzewska-Rosołowska
- 2 Department of Nephrology, Hypertension, and Internal Medicine with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
| | - Tomasz Hryszko
- 2 Department of Nephrology, Hypertension, and Internal Medicine with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
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Stankowski K, Figliozzi S, Battaglia V, Catapano F, Francone M, Monti L. Fabry Disease: More than a Phenocopy of Hypertrophic Cardiomyopathy. J Clin Med 2023; 12:7061. [PMID: 38002674 PMCID: PMC10671939 DOI: 10.3390/jcm12227061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Fabry disease (FD) is a genetic lysosomal storage disease with frequent cardiovascular involvement, whose presence is a major determinant of adverse clinical outcomes. As a potentially treatable cause of left ventricular hypertrophy (LVH) and heart failure with preserved ejection fraction, the early recognition of FD is crucial to initiate enzyme replacement therapy and improve long-term prognosis. Multimodality imaging plays a central role in the evaluation of patients with FD and helps in the differential diagnosis of other conditions presenting with LVH. In the present review, we explore the current applications of multimodality cardiac imaging, in particular echocardiography and cardiovascular magnetic resonance, in the diagnosis, prognostic assessment, and follow-up of patients with FD.
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Affiliation(s)
- Kamil Stankowski
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy; (K.S.); (S.F.); (V.B.); (F.C.); (M.F.)
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Stefano Figliozzi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy; (K.S.); (S.F.); (V.B.); (F.C.); (M.F.)
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Vincenzo Battaglia
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy; (K.S.); (S.F.); (V.B.); (F.C.); (M.F.)
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Federica Catapano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy; (K.S.); (S.F.); (V.B.); (F.C.); (M.F.)
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy; (K.S.); (S.F.); (V.B.); (F.C.); (M.F.)
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Lorenzo Monti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy; (K.S.); (S.F.); (V.B.); (F.C.); (M.F.)
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
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Pogoda C, Brand SM, Duning T, Schmidt-Pogoda A, Sindermann J, Lenders M, Brand E. Impact of enzyme replacement therapy and migalastat on left atrial strain and cardiomyopathy in patients with Fabry disease. Front Cardiovasc Med 2023; 10:1223635. [PMID: 38028489 PMCID: PMC10656767 DOI: 10.3389/fcvm.2023.1223635] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Aims Cardiomyopathy in Fabry disease (FD) is a major determinant of morbidity and mortality. This study investigates the effects of FD-specific treatment using enzyme replacement therapy (ERT) and chaperone therapy on left atrial (LA) function using two-dimensional speckle tracking echocardiography (2DSTE). Methods and results In this prospective observational single-center study, 20 FD patients [10 (50%) females] treated with migalastat, 48 FD patients [24 (50%) females] treated with ERT (agalsidase-alfa and agalsidase-beta), and 30 untreated FD patients (all females) as controls were analyzed. The mean follow-up time ranged from 26 to 81 months. 2DSTE was performed for left ventricle strain, right ventricle strain, and LA strain (LAS). FD-specific treated patients presented with increased left ventricular mass index (LVMi) and higher frequency of left ventricular hypertrophy at baseline, whereas untreated control patients showed normal baseline values. FD-specific treated (including migalastat and ERT) patients showed stabilization of LAS over time (p > 0.05). LVMi was also stable in treated FD patients during observation (p > 0.05). Conclusion In patients with FD, treated with either ERT or chaperone therapy, LAS values measured by echocardiographic speckle tracking were stable over time, pointing toward disease stabilization.
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Affiliation(s)
- Christian Pogoda
- Department of Cardiology I—Coronary and Peripheral Vascular Disease, Heart Failure, and Interdisciplinary Fabry Center (IFAZ), University Hospital Münster, Münster, Germany
| | - Stefan-Martin Brand
- Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease, and Interdisciplinary Fabry Center (IFAZ), University Hospital Münster, Münster, Germany
| | - Thomas Duning
- Department of Neurology, and Interdisciplinary Fabry Center (IFAZ), University Hospital Münster, Münster, Germany
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
| | - Antje Schmidt-Pogoda
- Department of Neurology, and Interdisciplinary Fabry Center (IFAZ), University Hospital Münster, Münster, Germany
| | - Jürgen Sindermann
- Interdisciplinary Heart Failure Section, University Hospital Münster, Münster, Germany
| | - Malte Lenders
- Department of Internal Medicine D, and Interdisciplinary Fabry Center (IFAZ), University Hospital Münster, Münster, Germany
| | - Eva Brand
- Department of Internal Medicine D, and Interdisciplinary Fabry Center (IFAZ), University Hospital Münster, Münster, Germany
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Savostyanov K, Pushkov A, Zhanin I, Mazanova N, Pakhomov A, Trufanova E, Alexeeva A, Sladkov D, Kuzenkova L, Asanov A, Fisenko A. Genotype-Phenotype Correlations in 293 Russian Patients with Causal Fabry Disease Variants. Genes (Basel) 2023; 14:2016. [PMID: 38002959 PMCID: PMC10671142 DOI: 10.3390/genes14112016] [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: 09/22/2023] [Revised: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Fabry disease (FD) is a rare hereditary multisystem disease caused by variants of the GLA gene. Determination of GLA gene variants and identification of genotype-phenotype correlations allow us to explain the features of FD associated with predominant damage of one or another system, both in the classical and atypical forms of FD, as well as in cases with late manifestation and involvement of one of the systems. METHODS The study included 293 Russian patients with pathogenic variants of the GLA gene, which were identified as a result of various selective screening programs. Screening was carried out for 48,428 high-risk patients using a two-step diagnostic algorithm, including the determination of the concentration of the biomarker lyso-Gb3 as a first-tier test. Screening of atypical FD among patients with HCM was carried out via high-throughput sequencing in another 2427 patients. RESULTS 102 (0.20%) cases of FD were identified among unrelated patients as a result of the study of 50,855 patients. Molecular genetic testing allowed us to reveal the spectrum and frequencies of 104 different pathogenic variants of the GLA gene in 293 examined patients from 133 families. The spectrum and frequencies of clinical manifestations in patients with FD, including 20 pediatric patients, were described. Correlations between the concentration of the lyso-Gb3 biomarker and the type of pathogenic variants of the GLA gene have been established. Variants identified in patients with early stroke were described, and the association of certain variants with the development of stroke was established. CONCLUSIONS The results of a large-scale selective FD screening, as well as clinical and molecular genetic features, in a cohort of 293 Russian patients with FD are described.
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Affiliation(s)
- Kirill Savostyanov
- FSAI National Medical Research Center for Children’s Health of the Russian Federation Ministry of Health, Moscow 119991, Russia; (A.P.); (I.Z.); (N.M.); (A.P.); (E.T.); (A.A.); (D.S.); (L.K.); (A.F.)
| | - Alexander Pushkov
- FSAI National Medical Research Center for Children’s Health of the Russian Federation Ministry of Health, Moscow 119991, Russia; (A.P.); (I.Z.); (N.M.); (A.P.); (E.T.); (A.A.); (D.S.); (L.K.); (A.F.)
| | - Ilya Zhanin
- FSAI National Medical Research Center for Children’s Health of the Russian Federation Ministry of Health, Moscow 119991, Russia; (A.P.); (I.Z.); (N.M.); (A.P.); (E.T.); (A.A.); (D.S.); (L.K.); (A.F.)
| | - Natalya Mazanova
- FSAI National Medical Research Center for Children’s Health of the Russian Federation Ministry of Health, Moscow 119991, Russia; (A.P.); (I.Z.); (N.M.); (A.P.); (E.T.); (A.A.); (D.S.); (L.K.); (A.F.)
| | - Alexander Pakhomov
- FSAI National Medical Research Center for Children’s Health of the Russian Federation Ministry of Health, Moscow 119991, Russia; (A.P.); (I.Z.); (N.M.); (A.P.); (E.T.); (A.A.); (D.S.); (L.K.); (A.F.)
| | - Elena Trufanova
- FSAI National Medical Research Center for Children’s Health of the Russian Federation Ministry of Health, Moscow 119991, Russia; (A.P.); (I.Z.); (N.M.); (A.P.); (E.T.); (A.A.); (D.S.); (L.K.); (A.F.)
| | - Alina Alexeeva
- FSAI National Medical Research Center for Children’s Health of the Russian Federation Ministry of Health, Moscow 119991, Russia; (A.P.); (I.Z.); (N.M.); (A.P.); (E.T.); (A.A.); (D.S.); (L.K.); (A.F.)
| | - Dmitry Sladkov
- FSAI National Medical Research Center for Children’s Health of the Russian Federation Ministry of Health, Moscow 119991, Russia; (A.P.); (I.Z.); (N.M.); (A.P.); (E.T.); (A.A.); (D.S.); (L.K.); (A.F.)
| | - Ludmila Kuzenkova
- FSAI National Medical Research Center for Children’s Health of the Russian Federation Ministry of Health, Moscow 119991, Russia; (A.P.); (I.Z.); (N.M.); (A.P.); (E.T.); (A.A.); (D.S.); (L.K.); (A.F.)
| | - Aliy Asanov
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow 119991, Russia;
| | - Andrey Fisenko
- FSAI National Medical Research Center for Children’s Health of the Russian Federation Ministry of Health, Moscow 119991, Russia; (A.P.); (I.Z.); (N.M.); (A.P.); (E.T.); (A.A.); (D.S.); (L.K.); (A.F.)
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Kokotis P, Zompola C, Anastasakis A, Damianaki A, Bountziouka C, Mpora M, Papatheodorou S, Tsivgoulis G. Clinical significance of small nerve fiber involvement in the early diagnosis and treatment of patients with Fabry disease. J Neurol Sci 2023; 453:120776. [PMID: 37797349 DOI: 10.1016/j.jns.2023.120776] [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: 07/05/2023] [Revised: 08/16/2023] [Accepted: 08/24/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION Peripheral nervous system is early involved in Fabry disease (FD) and preferentially the small nerve fibers, causing the characteristic neuropathic pain crises usually beginning in childhood. Early detection of this likely underdiagnosed disease is an important approach because causal therapies are available. METHODS We conducted a case-series study to investigate the small nerve fiber involvement in FD and its contribution to the diagnosis of the disease but also to the timely effective therapy administration. We used specific structured scales of symptoms and signs to detect peripheral neuropathy, as well as suitable functional and structural tests to diagnose the small fiber neuropathy (SFN). RESULTS Twenty-seven consecutive patients (14 men, mean age 44.62 ± 10.70 years) with suspected FD were included in this study. Most of the patients presented symptoms of small nerve fiber involvement, which were accompanied by abnormal test results, fulfilling the criteria for SFN. The detection of SFN in our patients allowed the completion of the FD diagnostic criteria and thus the initiation of therapy. In five patients the SFN diagnosis determined the administration of therapy, whereas in two others it might be considered. CONCLUSION Our results further suggest the importance of early diagnosis of peripheral neuropathy, especially of small nerve fiber involvement, in patients with suspected FD as it contributes crucially not only to the diagnosis but also to the timely effective initiation of FD therapy.
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Affiliation(s)
- Panagiotis Kokotis
- First Department of Neurology, Aeginition hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Christina Zompola
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aris Anastasakis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Center, Athens, Greece
| | - Aikaterini Damianaki
- Nephrology Department, General Hospital of Athens Ippokrateio, Athens, Greece; Service of Nephrology and Hypertension, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Chrysanthi Bountziouka
- First Department of Neurology, Aeginition hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Margarita Mpora
- Nephrology Department, General Hospital of Athens Ippokrateio, Athens, Greece
| | - Stathis Papatheodorou
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Center, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Meucci MC, Lillo R, Del Franco A, Monda E, Iannaccone G, Baldassarre R, Di Nicola F, Parisi V, Lombardo A, Spinelli L, Biagini E, Pieroni M, Pisani A, Crea F, Iaccarino G, Limongelli G, Olivotto I, Graziani F. Prognostic Implications of the Extent of Cardiac Damage in Patients With Fabry Disease. J Am Coll Cardiol 2023; 82:1524-1534. [PMID: 37793750 DOI: 10.1016/j.jacc.2023.07.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND There is limited evidence on the risk stratification of cardiovascular outcomes in patients with Fabry disease (FD). OBJECTIVES This study sought to classify FD patients into disease stages, based on the extent of the cardiac damage evaluated by echocardiography, and to assess their prognostic impact in a multicenter cohort. METHODS Patients with FD from 5 Italian referral centers were categorized into 4 stages: stage 0, no cardiac involvement; stage 1, left ventricular (LV) hypertrophy (LV maximal wall thickness >12 mm); stage 2, left atrium (LA) enlargement (LA volume index >34 mL/m2); stage 3, ventricular impairment (LV ejection fraction <50% or E/e' ≥15 or TAPSE <17 mm). The study endpoint was the composite of all-cause death, hospitalization for heart failure, new-onset atrial fibrillation, major bradyarrhythmias or tachyarrhythmias, and ischemic stroke. RESULTS A total of 314 patients were included. Among them, 174 (56%) were classified as stage 0, 41 (13%) as stage 1, 57 (18%) as stage 2 and 42 (13%) as stage 3. A progressive increase in the composite event rate at 8 years was observed with worsening stages of cardiac damage (log-rank P < 0.001). On multivariable Cox regression analysis, the staging was independently associated with the risk of cardiovascular events (HR: 2.086 per 1-stage increase; 95% CI: 1.487-2.927; P < 0.001). Notably, cardiac staging demonstrated a stronger and additive prognostic value, as compared with the degree of LV hypertrophy. CONCLUSIONS In FD patients, a novel staging classification of cardiac damage, evaluated by echocardiography, is strongly associated with cardiovascular outcomes and may be helpful to refine risk stratification.
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Affiliation(s)
- Maria Chiara Meucci
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosa Lillo
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Annamaria Del Franco
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Department of Clinical and Experimental Medicine, University of Florence, Italy
| | - Emanuele Monda
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Giulia Iannaccone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Riccardo Baldassarre
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Federico Di Nicola
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Vanda Parisi
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonella Lombardo
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Letizia Spinelli
- Interdepartmental Center of Research on Hypertension and Related Conditions (CIRIAPA), Federico II University, Naples, Italy
| | - Elena Biagini
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Antonio Pisani
- Interdepartmental Center of Research on Hypertension and Related Conditions (CIRIAPA), Federico II University, Naples, Italy; Department of Public Health, Nephrology Unit, Federico II University, Naples, Italy
| | - Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pneumological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Guido Iaccarino
- Interdepartmental Center of Research on Hypertension and Related Conditions (CIRIAPA), Federico II University, Naples, Italy; Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Department of Clinical and Experimental Medicine, University of Florence, Italy; Meyer Children's Hospital IRCCS, Florence, Italy
| | - Francesca Graziani
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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da Paz OT, Lacerda RCT, de Andrade LGM. Genetic and phenotypic profile of Fabry disease in the population of Vale do Paraiba and Eastern São Paulo. J Bras Nefrol 2023; 45:424-439. [PMID: 36745055 PMCID: PMC10726653 DOI: 10.1590/2175-8239-jbn-2022-0107en] [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: 06/26/2022] [Accepted: 12/19/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Fabry disease (FD) is an inborn error of metabolism characterized by α-galactosidase A deficiency. The primary objective was to evaluate the genetic and phenotypic profile of Fabry disease in hemodialysis. METHODS Observational cohort study to determine the incidence of genetic variations and phenotypic changes for FD in hemodialysis patients in the Paraiba Valley and Eastern São Paulo. Genetic testing for the GLA gene was performed for men and women over 12 years of age at the hemodialysis clinics between January 2016 and December 2019 as a screening protocol. RESULTS The cases came from screening exams of the index case among patients with chronic kidney disease, resulting in 17 families and totaling 82 patients under study. The classification of the most prevalent variant was that of uncertain significance (54%), followed by the pathogenic variant (46%). Five patients in two families were described with two types of variants not previously described in the literature, with pathogenic behavior. Comparing the types of variants, the presence of a pathogenic variant was associated with higher levels of lysoGB3, lower values for alpha-GAL activity and higher frequency of symptoms related to FD. CONCLUSION We characterized an extensive population of patients with FD variants with rich genetic, clinical and biomarker details. We believe that this study can help to better characterize the Brazilian population with FD and the most frequent types of variants.
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Choi SJ, Kim SH, Lee MS, Park S, Cho E, Han SS, Koh ES, Chung BH, Jeong KH, Bae EH, Lee EY, Kwon YJ. A questionnaire survey on the diagnosis and treatment of Fabry nephropathy in clinical practice. Kidney Res Clin Pract 2023; 42:628-638. [PMID: 37448283 PMCID: PMC10565450 DOI: 10.23876/j.krcp.22.235] [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: 10/16/2022] [Revised: 01/27/2023] [Accepted: 02/06/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Fabry nephropathy is characterized by a deficiency of lysosomal alpha-galactosidase A, which results in proteinuria and kidney disease. The ineffectiveness of enzyme replacement therapy (ERT) for severe kidney failure highlights the need for early detection and meaningful markers. However, because the diagnosis and treatment of Fabry disease can vary according to the expertise of physicians, we evaluated the opinions of Korean specialists. METHODS A questionnaire regarding the management of Fabry nephropathy was emailed to healthcare providers with the experience or ability to treat individuals with Fabry nephropathy. RESULTS Of the 70 experts who responded to the survey, 43 were nephrologists, and 64.3% of the respondents reported having treated patients with Fabry disease. Pediatricians are treating primarily patients with classic types of the disease, while nephrologists and cardiologists are treating more patients with variant types. Only 40.7% of non-nephrologists agreed that a kidney biopsy was required at the time of diagnosis, compared with 81.4% of nephrologists. Thirty-eight of 70 respondents (54.3%) reported measuring globotriaosylsphingosine (lyso-Gb3) as a biomarker. The most common period to measure lyso-Gb3 was at the time of diagnosis, followed by after ERT, before ERT, and at screening. For the stage at which ERT should begin, microalbuminuria and proteinuria were chosen by 51.8% and 28.6% of respondents, respectively. CONCLUSION Nephrologists are more likely to treat variant Fabry disease rather than classic cases, and they agree that ERT should be initiated early in Fabry nephropathy, using lyso-Gb3 as a biomarker.
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Affiliation(s)
- Soo Jeong Choi
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Su Hyun Kim
- Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea
| | - Min Sung Lee
- Department of Internal Medicine, Ewha Womans University Medical Center, Seoul, Republic of Korea
| | - Samel Park
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Eunjung Cho
- Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Kore
| | - Eun Sil Koh
- Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung Ha Chung
- Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung Hwan Jeong
- Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Eun Young Lee
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Young Joo Kwon
- Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Bichet DG, Hopkin RJ, Aguiar P, Allam SR, Chien YH, Giugliani R, Kallish S, Kineen S, Lidove O, Niu DM, Olivotto I, Politei J, Rakoski P, Torra R, Tøndel C, Hughes DA. Consensus recommendations for the treatment and management of patients with Fabry disease on migalastat: a modified Delphi study. Front Med (Lausanne) 2023; 10:1220637. [PMID: 37727761 PMCID: PMC10505750 DOI: 10.3389/fmed.2023.1220637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/13/2023] [Indexed: 09/21/2023] Open
Abstract
Objective Fabry disease is a progressive disorder caused by deficiency of the α-galactosidase A enzyme (α-Gal A), leading to multisystemic organ damage with heterogenous clinical presentation. The addition of the oral chaperone therapy migalastat to the available treatment options for Fabry disease is not yet universally reflected in all treatment guidelines. These consensus recommendations are intended to provide guidance for the treatment and monitoring of patients with Fabry disease receiving migalastat. Methods A modified Delphi process was conducted to determine consensus on treatment decisions and monitoring of patients with Fabry disease receiving migalastat. The multidisciplinary panel comprised 14 expert physicians across nine specialties and two patients with Fabry disease. Two rounds of Delphi surveys were completed and recommendations on the use of biomarkers, multidisciplinary monitoring, and treatment decisions were generated based on statements that reached consensus. Results The expert panel reached consensus agreement on 49 of 54 statements, including 16 that reached consensus in round 1. Statements that reached consensus agreement are summarized in recommendations for migalastat treatment and monitoring, including baseline and follow-up assessments and frequency. All patients with Fabry disease and an amenable mutation may initiate migalastat treatment if they have evidence of Fabry-related symptoms and/or organ involvement. Treatment decisions should include holistic assessment of the patient, considering clinical symptoms and organ involvement as well as patient-reported outcomes and patient preference. The reliability of α-Gal A and globotriaosylsphingosine as pharmacodynamic response biomarkers remains unclear. Conclusion These recommendations build on previously published guidelines to highlight the importance of holistic, multidisciplinary monitoring for patients with Fabry disease receiving migalastat, in addition to shared decision-making regarding treatments and monitoring throughout the patient journey. GRAPHICAL ABSTRACT.
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Affiliation(s)
- Daniel G. Bichet
- Department of Medicine, Pharmacology and Physiology, Hôpital du Sacré-Coeur, University of Montréal, Montreal, QC, Canada
| | - Robert J. Hopkin
- Department of Pediatrics, Division of Human Genetics, University of Cincinnati College of Medicine, and Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Patrício Aguiar
- Inborn Errors of Metabolism Reference Center, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - Sridhar R. Allam
- Burnett School of Medicine, Texas Christian University, Fort Worth, TX, United States
- Tarrant Nephrology Associates/PPG Health, Fort Worth, TX, United States
| | - Yin-Hsiu Chien
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan
- Department of Pediatrics, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Roberto Giugliani
- Postgraduate Program in Genetics and Molecular Biology (PPGBM) at Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- BioDiscovery Laboratory at Hospital de Clinicas de Porto Alegre (HCPA), National Institute of Population Medical Genetics (INAGEMP), DASA, Casa dos Raros, Porto Alegre, Brazil
| | - Staci Kallish
- Division of Translational Medicine and Human Genetics, Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Olivier Lidove
- Department of Internal Medicine-Rheumatology, Croix Saint Simon Hospital, Paris, France
- French Network of Inherited Metabolic Disorders (G2m), France
| | - Dau-Ming Niu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Iacopo Olivotto
- Department of Experimental and Clinical Medicine, Meyer University Children’s Hospital, Florence, Italy
| | - Juan Politei
- Department of Neurology, Fundacion Para el Estudio de Enfermedades Neurometabolicas (FESEN), Buenos Aires, Argentina
| | | | - Roser Torra
- Inherited Kidney Disorders, Department of Nephrology, Fundació Puigvert, Institut d’Investigació Biomèdica Sant Pau (IIB-SANT PAU), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Camilla Tøndel
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Derralynn A. Hughes
- Lysosomal Storage Disorders Unit, Royal Free London NHS Foundation Trust and University College London, London, United Kingdom
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Burban A, Pucyło S, Sikora A, Opolski G, Grabowski M, Kołodzińska A. Hypertrophic Cardiomyopathy versus Storage Diseases with Myocardial Involvement. Int J Mol Sci 2023; 24:13239. [PMID: 37686045 PMCID: PMC10488064 DOI: 10.3390/ijms241713239] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
One of the main causes of heart failure is cardiomyopathies. Among them, the most common is hypertrophic cardiomyopathy (HCM), characterized by thickening of the left ventricular muscle. This article focuses on HCM and other cardiomyopathies with myocardial hypertrophy, including Fabry disease, Pompe disease, and Danon disease. The genetics and pathogenesis of these diseases are described, as well as current and experimental treatment options, such as pharmacological intervention and the potential of gene therapies. Although genetic approaches are promising and have the potential to become the best treatments for these diseases, further research is needed to evaluate their efficacy and safety. This article describes current knowledge and advances in the treatment of the aforementioned cardiomyopathies.
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Affiliation(s)
- Anna Burban
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa, Poland; (A.B.); (S.P.); (A.S.); (G.O.); (M.G.)
- Doctoral School, Medical University of Warsaw, 81 Żwirki i Wigury Street, 02-091 Warsaw, Poland
| | - Szymon Pucyło
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa, Poland; (A.B.); (S.P.); (A.S.); (G.O.); (M.G.)
| | - Aleksandra Sikora
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa, Poland; (A.B.); (S.P.); (A.S.); (G.O.); (M.G.)
| | - Grzegorz Opolski
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa, Poland; (A.B.); (S.P.); (A.S.); (G.O.); (M.G.)
| | - Marcin Grabowski
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa, Poland; (A.B.); (S.P.); (A.S.); (G.O.); (M.G.)
| | - Agnieszka Kołodzińska
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa, Poland; (A.B.); (S.P.); (A.S.); (G.O.); (M.G.)
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Stepien KM, Broomfield A, Cole D, Deegan PB, Forshaw-Hulme S, Hughes D, Jovanovic A, Morris L, Muir A, Ramaswami U. Management of pain in Fabry disease in the UK clinical setting: consensus findings from an expert Delphi panel. Orphanet J Rare Dis 2023; 18:203. [PMID: 37480023 PMCID: PMC10362568 DOI: 10.1186/s13023-023-02796-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 07/05/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Fabry disease is a rare, X-linked inherited lysosomal storage disorder, that manifests as a heterogeneous disease with renal, cardiac and nervous system involvement. The most common pain experienced by people with Fabry disease are episodes of neuropathic pain reported in up to 80% of classical hemizygous male patients and up to 65% of heterozygous female patients. No clear consensus exists within UK clinical practice for the assessment and management of pain in Fabry disease based on agreed clinical practice and clinical experience. Here we describe a modified Delphi initiative to establish expert consensus on management of pain in Fabry disease in the UK clinical setting. METHODS Delphi panel members were identified based on their demonstrated expertise in managing adult or paediatric patients with Fabry disease in the UK and recruited by an independent third-party administrator. Ten expert panellists agreed to participate in two survey rounds, during which they remained anonymous to each other. Circulation of the questionnaires, and collection and processing of the panel's responses were conducted between September 2021 and December 2021. All questions required an answer. RESULTS The Delphi panel reached a consensus on 21 out of 41 aspects of pain assessment and management of pain in Fabry disease. These encompassed steps in the care pathway from the goals of therapy through to holistic support, including the use of gabapentin and carbamazepine as first-line analgesic medications for the treatment of neuropathic pain in Fabry disease, as well as the proactive management of symptoms of anxiety and/or depression associated with Fabry pain. CONCLUSIONS The consensus panel outcomes reported here have highlighted strengths in current UK clinical practice, along with unmet needs for further research and agreement. This consensus is intended to prompt the next steps towards developing clinical guidelines.
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Affiliation(s)
- Karolina M Stepien
- The Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Salford, UK.
| | - Alexander Broomfield
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Duncan Cole
- Department of Medical Biochemistry and Immunology, University Hospital of Wales, Cardiff, Wales, UK
| | | | - Stuart Forshaw-Hulme
- The Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - Derralynn Hughes
- Lysosomal Storage Disorders Unit, Royal Free London NHS Foundation Trust, London, UK
| | - Ana Jovanovic
- The Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - Liz Morris
- Lysosomal Disorders Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Alison Muir
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, UK
| | - Uma Ramaswami
- Lysosomal Storage Disorders Unit, Royal Free London NHS Foundation Trust, London, UK
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Eskes ECB, van der Lienden MJC, Sjouke B, van Vliet L, Brands MMMG, Hollak CEM, Aerts JMFG. Glycoprotein non-metastatic protein B (GPNMB) plasma values in patients with chronic visceral acid sphingomyelinase deficiency. Mol Genet Metab 2023; 139:107631. [PMID: 37453187 DOI: 10.1016/j.ymgme.2023.107631] [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: 03/27/2023] [Revised: 06/23/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023]
Abstract
Acid sphingomyelinase deficiency (ASMD) is a rare LSD characterized by lysosomal accumulation of sphingomyelin, primarily in macrophages. With the recent availability of enzyme replacement therapy, the need for biomarkers to assess severity of disease has increased. Glycoprotein non-metastatic protein B (GPNMB) plasma levels were demonstrated to be elevated in Gaucher disease. Given the similarities between Gaucher disease and ASMD, the hypothesis was that GPNMB might be a potential biochemical marker for ASMD as well. Plasma samples of ASMD patients were analyzed and GPNMB plasma levels were compared to those of healthy volunteers. Visceral disease severity was classified as severe when splenic, hepatic and pulmonary manifestations were all present and as mild to moderate if this was not the case. Median GPNMB levels in 67 samples of 19 ASMD patients were 185 ng/ml (range 70-811 ng/ml) and were increased compared to 10 healthy controls (median 36 ng/ml, range 9-175 ng/ml, p < 0.001). Median plasma GPNMB levels of ASMD patients with mild to moderate visceral disease compared to patients with severe visceral disease differed significantly and did not overlap (respectively 109 ng/ml, range 70-304 ng/ml and 325 ng/ml, range 165-811 ng/ml, p < 0.001). Correlations with other biochemical markers of ASMD (i.e. chitotriosidase activity, CCL18 and lysosphingomyelin, respectively R = 0.28, p = 0.270; R = 0.34, p = 0.180; R = 0.39, p = 0.100) and clinical parameters (i.e. spleen volume, liver volume, diffusion capacity and forced vital capacity, respectively R = 0.59, p = 0.061, R = 0.5, p = 0.100, R = 0.065, p = 0.810, R = -0.38, p = 0.160) could not be established within this study. The results of this study suggest that GPNMB might be suitable as a biomarker of visceral disease severity in ASMD. Correlations between GPNMB and biochemical or clinical markers of ASMD and response to therapy have to be studied in a larger cohort.
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Affiliation(s)
- Eline C B Eskes
- Amsterdam UMC, University of Amsterdam, Department of Endocrinology and Metabolism, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Inborn Errors of Metabolism, Amsterdam, the Netherlands
| | - Martijn J C van der Lienden
- Leiden Institute of Chemistry, University of Leiden, Department of Medical Biochemistry, Einsteinweg 55, 2333 CC Leiden, the Netherlands
| | - Barbara Sjouke
- Amsterdam UMC, University of Amsterdam, Department of Endocrinology and Metabolism, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Inborn Errors of Metabolism, Amsterdam, the Netherlands
| | - Laura van Vliet
- Leiden Institute of Chemistry, University of Leiden, Department of Medical Biochemistry, Einsteinweg 55, 2333 CC Leiden, the Netherlands
| | - Marion M M G Brands
- Amsterdam Gastroenterology Endocrinology Metabolism, Inborn Errors of Metabolism, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Division of Metabolic Diseases, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Carla E M Hollak
- Amsterdam UMC, University of Amsterdam, Department of Endocrinology and Metabolism, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Inborn Errors of Metabolism, Amsterdam, the Netherlands
| | - Johannes M F G Aerts
- Leiden Institute of Chemistry, University of Leiden, Department of Medical Biochemistry, Einsteinweg 55, 2333 CC Leiden, the Netherlands.
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Hughes DA, Bichet DG, Giugliani R, Hopkin RJ, Krusinska E, Nicholls K, Olivotto I, Feldt-Rasmussen U, Sakai N, Skuban N, Sunder-Plassmann G, Torra R, Wilcox WR. Long-term multisystemic efficacy of migalastat on Fabry-associated clinical events, including renal, cardiac and cerebrovascular outcomes. J Med Genet 2023; 60:722-731. [PMID: 36543533 PMCID: PMC10359570 DOI: 10.1136/jmg-2022-108669] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Fabry disease is a rare, multisystemic disorder caused by GLA gene variants that lead to alpha galactosidase A deficiency, resulting in accumulation of glycosphingolipids and cellular dysfunction. Fabry-associated clinical events (FACEs) cause significant morbidity and mortality, yet the long-term effect of Fabry therapies on FACE incidence remains unclear. METHODS This posthoc analysis evaluated incidence of FACEs (as a composite outcome and separately for renal, cardiac and cerebrovascular events) in 97 enzyme replacement therapy (ERT)-naïve and ERT-experienced adults with Fabry disease and amenable GLA variants who were treated with migalastat for up to 8.6 years (median: 5 years) in Phase III clinical trials of migalastat. Associations between baseline characteristics and incidence of FACEs were also evaluated. RESULTS During long-term migalastat treatment, 17 patients (17.5%) experienced 22 FACEs and there were no deaths. The incidence rate of FACEs was 48.3 events per 1000 patient-years overall. Numerically higher incidence rates were observed in men versus women, patients aged >40 years versus younger patients, ERT-naïve versus ERT-experienced patients and men with the classic phenotype versus men and women with all other phenotypes. There was no statistically significant difference in time to first FACE when analysed by patient sex, phenotype, prior treatment status or age. Lower baseline estimated glomerular filtration rate (eGFR) was associated with an increased risk of FACEs across patient populations. CONCLUSIONS The overall incidence of FACEs for patients during long-term treatment with migalastat compared favourably with historic reports involving ERT. Lower baseline eGFR was a significant predictor of FACEs.
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Affiliation(s)
- Derralynn A Hughes
- Lysosomal Storage Disorders Unit, Royal Free London NHS Foundation Trust and University College London, London, UK
| | - Daniel G Bichet
- Hôpital du Sacré Coeur, University of Montréal, Montréal, Quebec, Canada
| | - Roberto Giugliani
- Medical Genetics Service, HCPA, Department of Genetics, UFRGS, DASA and INAGEMP, Porto Alegre, Brazil
| | - Robert J Hopkin
- Division of Human Genetics, College of Medicine, Department of Pediatrics, Cincinnati Children's Hospital and University of Cincinnati, Cincinnati, Ohio, USA
| | - Eva Krusinska
- Clinical Development, Amicus Therapeutics Inc, Philadelphia, Pennsylvania, USA
| | - Kathleen Nicholls
- Department of Nephrology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, National University Hospital, Copenhagen University, Copenhagen, Denmark
| | - Norio Sakai
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Nina Skuban
- Clinical Development, Amicus Therapeutics Inc, Philadelphia, Pennsylvania, USA
| | - Gere Sunder-Plassmann
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Roser Torra
- Inherited Renal Disorders, Nephrology Department, Fundació Puigvert, IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - William R Wilcox
- Department of Human Genetics, Emory University, Atlanta, Georgia, USA
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Corchete Prats E, González-Parra E, Vega A, Macías N, Delgado M, Fernández M, Sánchez RJ, Álvarez L, Miranda RJ, Vian J, López V, Mérida E, Pereira M, Sapiencia D, Andrés N, Muñoz P, Gil Y, Sánchez M, Cases C, Gil B, García A, Sainz V, Alexandru S, Pampa S, López M, Flor JCDL, Estrada PN, Berlanga JR, Zamora R, Sánchez R, Rodríguez-Osorio L, Fraile C, Caravaca-Fontán F, Moratilla C, Cabré C, Furaz K, Nieto L, Villaverde MT, Tapia CG, Cedeño S, Castellano S, Valdés E, Ferreira M, Martínez P, Sanz M, Sánchez M, Ríos F, Palomo S, Serrano ML, Blanco A, Espinel L, Tornero F, Herrero JA. Epidemiology of Fabry disease in patients in hemodialysis in the Madrid community. Nefrologia 2023; 43:435-441. [PMID: 36564230 DOI: 10.1016/j.nefroe.2022.03.008] [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: 10/15/2021] [Accepted: 03/03/2022] [Indexed: 06/17/2023] Open
Abstract
This study screened for Fabry disease (FD) in patients in hemodialysis (HD) in the region of Madrid (CAM) with a cross-sectional design to evaluate HD-prevalent patients, followed by a three-year period prospective design to analyze HD-incident patients. INCLUSION CRITERIA patients older than 18 years on HD in the CAM, excluding patients diagnosed with any other hereditary disease with renal involvement different from FD, that sign the Informed Consent (IC). EXCLUSION CRITERIA underaged patients or not agreeing or not being capable of signing the IC. RESULTS 3470 patients were included, 63% males and with an average age of 67.9±9.7 years. 2357 were HD-prevalent patients and 1113 HD-incident patients. For HD-prevalent patients, average time in HD was 45.2 months (SD 51.3), in HD-incident patients proteinuria was present in 28.4%. There were no statistical differences in plasmatic alpha-galactosidase A (α-GAL-A) activity or Lyso-GL-3 values when comparing HD-prevalent and HD-incident populations and neither between males and females. A genetic study was performed in 87 patients (2.5% of patients): 60 male patients with decreased enzymatic activity and 27 female patients either with a decreased GLA activity, increased Lyso-Gl3 levels or both. The genetic variants identified were: p.Asp313Tyr (4 patients), p.Arg220Gln (3 patients) and M290I (1 patient). None of the identified variants is pathogenic. CONCLUSIONS 76% of HD Centers of the CAM participated in the study. This is the first publication to describe the prevalence of FD in the HD-population of a region of Spain as well as its average α-GAL-A-activity and plasmatic Lyso-Gl3 levels. It is also the first study that combines a cross-sectional design with a prospective follow-up design. This study has not identified any FD patient.
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Affiliation(s)
| | | | - Almudena Vega
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Nicolás Macías
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - María Delgado
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Milagros Fernández
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | | | - Laura Álvarez
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Ramón Jesús Miranda
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Javier Vian
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Virginia López
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Evangelina Mérida
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Mónica Pereira
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - David Sapiencia
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Natalia Andrés
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Patricia Muñoz
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Yohana Gil
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - María Sánchez
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Clara Cases
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Beatriz Gil
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Alicia García
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Valeria Sainz
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Simona Alexandru
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Saúl Pampa
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - María López
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | | | | | - José Ramón Berlanga
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Rocío Zamora
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Rosa Sánchez
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | | | - Carmen Fraile
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | | | - Cristina Moratilla
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Carmen Cabré
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Karina Furaz
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Luis Nieto
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | | | | | - Santiago Cedeño
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Sandra Castellano
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Evaristo Valdés
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Marta Ferreira
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Pilar Martínez
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Marta Sanz
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Mercedes Sánchez
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Francisco Ríos
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Sofía Palomo
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - María Luisa Serrano
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Ana Blanco
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Laura Espinel
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
| | - Fernando Tornero
- Hospital Universitario Infanta Leonor: Hospital Infanta Leonor, Madrid, Spain
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Gragnaniello V, Burlina AP, Commone A, Gueraldi D, Puma A, Porcù E, Stornaiuolo M, Cazzorla C, Burlina AB. Newborn Screening for Fabry Disease: Current Status of Knowledge. Int J Neonatal Screen 2023; 9:31. [PMID: 37367212 DOI: 10.3390/ijns9020031] [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: 04/03/2023] [Revised: 05/24/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
Fabry disease is an X-linked progressive lysosomal disorder, due to α-galactosidase A deficiency. Patients with a classic phenotype usually present in childhood as a multisystemic disease. Patients presenting with the later onset subtypes have cardiac, renal and neurological involvements in adulthood. Unfortunately, the diagnosis is often delayed until the organ damage is already irreversibly severe, making specific treatments less efficacious. For this reason, in the last two decades, newborn screening has been implemented to allow early diagnosis and treatment. This became possible with the application of the standard enzymology fluorometric method to dried blood spots. Then, high-throughput multiplexable assays, such as digital microfluidics and tandem mass spectrometry, were developed. Recently DNA-based methods have been applied to newborn screening in some countries. Using these methods, several newborn screening pilot studies and programs have been implemented worldwide. However, several concerns persist, and newborn screening for Fabry disease is still not universally accepted. In particular, enzyme-based methods miss a relevant number of affected females. Moreover, ethical issues are due to the large number of infants with later onset forms or variants of uncertain significance. Long term follow-up of individuals detected by newborn screening will improve our knowledge about the natural history of the disease, the phenotype prediction and the patients' management, allowing a better evaluation of risks and benefits of the newborn screening for Fabry disease.
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Affiliation(s)
- Vincenza Gragnaniello
- Division of Inherited Metabolic Diseases, Department of Diagnostic Services, University Hospital, 35128 Padua, Italy
| | | | - Anna Commone
- Division of Inherited Metabolic Diseases, Department of Diagnostic Services, University Hospital, 35128 Padua, Italy
| | - Daniela Gueraldi
- Division of Inherited Metabolic Diseases, Department of Diagnostic Services, University Hospital, 35128 Padua, Italy
| | - Andrea Puma
- Division of Inherited Metabolic Diseases, Department of Diagnostic Services, University Hospital, 35128 Padua, Italy
| | - Elena Porcù
- Division of Inherited Metabolic Diseases, Department of Diagnostic Services, University Hospital, 35128 Padua, Italy
| | - Maria Stornaiuolo
- Division of Inherited Metabolic Diseases, Department of Diagnostic Services, University Hospital, 35128 Padua, Italy
| | - Chiara Cazzorla
- Division of Inherited Metabolic Diseases, Department of Diagnostic Services, University Hospital, 35128 Padua, Italy
| | - Alberto B Burlina
- Division of Inherited Metabolic Diseases, Department of Diagnostic Services, University Hospital, 35128 Padua, Italy
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Averbuch T, White JA, Fine NM. Anderson-Fabry disease cardiomyopathy: an update on epidemiology, diagnostic approach, management and monitoring strategies. Front Cardiovasc Med 2023; 10:1152568. [PMID: 37332587 PMCID: PMC10272370 DOI: 10.3389/fcvm.2023.1152568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/09/2023] [Indexed: 06/20/2023] Open
Abstract
Anderson-Fabry disease (AFD) is an X-linked lysosomal storage disorder caused by deficient activity of the enzyme alpha-galactosidase. While AFD is recognized as a progressive multi-system disorder, infiltrative cardiomyopathy causing a number of cardiovascular manifestations is recognized as an important complication of this disease. AFD affects both men and women, although the clinical presentation typically varies by sex, with men presenting at a younger age with more neurologic and renal phenotype and women developing a later onset variant with more cardiovascular manifestations. AFD is an important cause of increased myocardial wall thickness, and advances in imaging, in particular cardiac magnetic resonance imaging and T1 mapping techniques, have improved the ability to identify this disease non-invasively. Diagnosis is confirmed by the presence of low alpha-galactosidase activity and identification of a mutation in the GLA gene. Enzyme replacement therapy remains the mainstay of disease modifying therapy, with two formulations currently approved. In addition, newer treatments such as oral chaperone therapy are now available for select patients, with a number of other investigational therapies in development. The availability of these therapies has significantly improved outcomes for AFD patients. Improved survival and the availability of multiple agents has presented new clinical dilemmas regarding disease monitoring and surveillance using clinical, imaging and laboratory biomarkers, in addition to improved approaches to managing cardiovascular risk factors and AFD complications. This review will provide an update on clinical recognition and diagnostic approaches including differentiation from other causes of increased ventricular wall thickness, in addition to modern strategies for management and follow-up.
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Affiliation(s)
- Tauben Averbuch
- Division of Cardiology, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - James A. White
- Division of Cardiology, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Center, Alberta Health Services, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nowell M. Fine
- Division of Cardiology, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
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Harigane Y, Morimoto I, Suzuki O, Temmoku J, Sakamoto T, Nakamura K, Machii K, Miyata M. Enzyme replacement therapy in two patients with classic Fabry disease from the same family tree: Two case reports. World J Clin Cases 2023; 11:3542-3551. [PMID: 37383915 PMCID: PMC10294186 DOI: 10.12998/wjcc.v11.i15.3542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/29/2023] [Accepted: 04/17/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND The pathophysiology of Fabry disease (FD)-induced progressive vital organ damage is irreversible. Disease progression can be delayed using enzyme replacement therapy (ERT). In patients with classic FD, sporadic accumulation of globotriaosylceramide (GL-3) in the heart and kidney begins in utero; however, until childhood, GL-3 accumulation is mild and reversible and can be restored by ERT. The current consensus is that ERT initiation during early childhood is paramount. Nonetheless, complete recovery of organs in patients with advanced FD is challenging.
CASE SUMMARY Two related male patients, an uncle (patient 1) and nephew (patient 2), presented with classic FD. Both patients were treated by us. Patient 1 was in his 50s, and ERT was initiated following end-organ damage; this was subsequently ineffective. He developed cerebral infarction and died of sudden cardiac arrest. Patient 2 was in his mid-30s, and ERT was initiated when the patient was diagnosed with FD, during which the damage to vital organs was not overtly apparent. Although he had left ventricular hypertrophy at the beginning of this treatment, the degree of hypertrophy progression was limited to a minimal range after > 18 years of ERT.
CONCLUSION We obtained discouraging ERT outcomes for older patients but encouraging outcomes for younger adults with classic FD.
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Affiliation(s)
- Yuki Harigane
- Department of Urology, Fukushima Medical University, Fukushima 960-1295, Japan
| | | | - O Suzuki
- Department of Diagnostic Pathology, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Jumpei Temmoku
- Center of Internal Medicine for Rheumatology and Collagen Disease, Fukushima Red Cross Hospital, Fukushima 960-8530, Japan
| | - Takayuki Sakamoto
- Department of Cardiology, Fukushima Red Cross Hospital, Fukushima 960-8530, Japan
| | - Kohichiro Nakamura
- Department of Neurology, Fukushima Red Cross Hospital, Fukushima 960-8530, Japan
| | - Kazuo Machii
- Machii Cardiology and Internal Medicine Clinic, Fukushima 960-8530, Japan
| | - Masayuki Miyata
- Center of Internal Medicine for Rheumatology and Collagen Disease, Fukushima Red Cross Hospital, Fukushima 960-8530, Japan
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Gilchrist M, Casanova F, Tyrrell JS, Cannon S, Wood AR, Fife N, Young K, Oram RA, Weedon MN. Prevalence of Fabry disease-causing variants in the UK Biobank. J Med Genet 2023; 60:391-396. [PMID: 35977816 PMCID: PMC10086508 DOI: 10.1136/jmg-2022-108523] [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: 03/08/2022] [Accepted: 07/15/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Fabry disease is an X-linked lysosomal storage disorder resulting from deficiency of the alpha-galactosidase A enzyme leading to accumulation of globotriaosylceramide in multiple organ sites with prominent cardiovascular and renal involvement. Global prevalence estimates of Fabry disease based on clinical ascertainment range from 1 in 40 000 to 1 in 170 000. We aimed to determine the prevalence of Fabry disease-causing variants in UK Biobank. METHODS We sought GLA gene variants in exome sequencing data from 200 643 individuals from UK Biobank. We used ACMG/AMP guidelines (American College of Medical Genetics/Association for Molecular Pathology) to classify pathogenicity and compared baseline biomarker data, hospital ICD-10 (International Classification of Diseases version-10) codes, general practitioner records and self-reported health data with those without pathogenic variants. RESULTS We identified 81 GLA coding variants. We identified eight likely pathogenic variants on the basis of being rare (<1/10 000 individuals) and either previously reported to cause Fabry disease, or being protein-truncating variants. Thirty-six individuals carried one of these variants. In the UK Biobank, the prevalence of likely pathogenic Fabry disease-causing variants is 1/5732 for late-onset disease-causing variants and 1/200 643 for variants causing classic Fabry disease. CONCLUSION Fabry disease-causing GLA variants are more prevalent in an unselected population sample than the reported prevalence of Fabry disease. These are overwhelmingly variants associated with later onset. It is possible the prevalence of later-onset Fabry disease exceeds current estimates.
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Affiliation(s)
- Mark Gilchrist
- College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | | | - Jess S Tyrrell
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Stuart Cannon
- College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Andrew R Wood
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UK
| | - Nicole Fife
- College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Katherine Young
- College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Richard A Oram
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Michael N Weedon
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
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Nickander J, Cole B, Nordin S, Vijapurapu R, Steeds RP, Moon JC, Kellman P, Ugander M, Kozor R. Increased cardiac involvement in Fabry disease using blood-corrected native T1 mapping. Sci Rep 2023; 13:4420. [PMID: 36932097 PMCID: PMC10023696 DOI: 10.1038/s41598-023-31211-9] [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: 07/18/2022] [Accepted: 03/08/2023] [Indexed: 03/19/2023] Open
Abstract
Fabry disease (FD) is a rare lysosomal storage disorder resulting in myocardial sphingolipid accumulation which is detectable by cardiovascular magnetic resonance as low native T1. However, myocardial T1 contains signal from intramyocardial blood which affects variability and consequently measurement precision and accuracy. Correction of myocardial T1 by blood T1 increases precision. We therefore deployed a multicenter study of FD patients (n = 218) and healthy controls (n = 117) to investigate if blood-correction of myocardial native T1 increases the number of FD patients with low T1, and thus reclassifies FD patients as having cardiac involvement. Cardiac involvement was defined as a native T1 value 2 standard deviations below site-specific means in healthy controls for both corrected and uncorrected measures. Overall low T1 was 135/218 (62%) uncorrected vs. 145/218 (67%) corrected (p = 0.02). With blood-correction, 13/83 previously normal patients were reclassified to low T1. This reclassification appears clinically relevant as 6/13 (46%) of reclassified had focal late gadolinium enhancement or left ventricular hypertrophy as signs of cardiac involvement. Blood-correction of myocardial native T1 increases the proportion of FD subjects with low myocardial T1, with blood-corrected results tracking other markers of cardiac involvement. Blood-correction may potentially offer earlier detection and therapy initiation, but merits further prospective studies.
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Affiliation(s)
- Jannike Nickander
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden.
| | - Ben Cole
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia
| | - Sabrina Nordin
- Institute of Cardiovascular Science, University College London, London, UK
| | - Ravi Vijapurapu
- Institute of Cardiovascular Science, University of Birmingham, Birmingham, UK
| | - Richard P Steeds
- Institute of Cardiovascular Science, University of Birmingham, Birmingham, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, London, UK
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia
- Charles Perkins Center, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Rebecca Kozor
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia
- Royal North Shore Hospital, North Shore Private Hospital, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
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Umer M, Kalra DK. Treatment of Fabry Disease: Established and Emerging Therapies. Pharmaceuticals (Basel) 2023; 16:320. [PMID: 37259462 PMCID: PMC9967779 DOI: 10.3390/ph16020320] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 01/14/2024] Open
Abstract
Fabry disease (FD) is a rare, X-linked inherited disorder of glycosphingolipid metabolism. It leads to the progressive accumulation of globotriaosylceramide within lysosomes due to a deficiency of α-galactosidase A enzyme. It involves multiple organs, predominantly the renal, cardiac, and cerebrovascular systems. Early diagnosis and treatment are critical to prevent progression to irreversible tissue damage and organ failure, and to halt life-threatening complications that can significantly reduce life expectancy. This review will focus on the established and emerging treatment options for FD.
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Affiliation(s)
| | - Dinesh K. Kalra
- Division of Cardiology, University of Louisville, Louisville, KY 40202, USA
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Paz OTD, Lacerda RCT, de Andrade LGM. Perfil genético e fenotípico da doença de Fabry na população do Vale do Paraíba e Zona Leste de São Paulo. J Bras Nefrol 2023. [DOI: 10.1590/2175-8239-jbn-2022-0107pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
RESUMO Introdução: A doença de Fabry (DF) é um erro inato do metabolismo caracterizado pela deficiência da enzima α-galactosidase A. O objetivo primário foi avaliar o perfil genético e fenotípico da doença de Fabry em hemodiálise. Métodos: Estudo de coorte observacional para determinar a incidência de variações genéticas e alterações fenotípicas para DF em pacientes em hemodiálise no Vale do Paraíba e Zona Leste de São Paulo. O teste genético para o gene GLA foi realizado para homens e mulheres em todos os pacientes das clínicas de hemodiálise maiores de 12 anos entre janeiro de 2016 a dezembro de 2019 como protocolo de rastreio. Resultados: Os casos foram provenientes de exames de triagem do caso índice entre pacientes portadores de doença renal crônica, resultando em 17 famílias e totalizando 82 pacientes em estudo. A classificação da variante mais prevalente foi a de significado incerto (54%), seguida da variante patogênica (46%). Foram descritos 5 pacientes em duas famílias com dois tipos de variantes ainda não previamente descritos na literatura com comportamento patogênico. Na comparação entre os tipos de variantes, a presença de variante patogênica foi associada a maiores níveis de lysoGB3, menores valores da atividade da alfa-GAL e maior frequência de sintomas relativos à DF. Conclusão: Caracterizamos uma extensa população de pacientes com variantes para DF com riqueza de detalhes de genética, clínica e de biomarcadores. Acreditamos que este estudo possa auxiliar na melhor caracterização da população brasileira com DF e nos tipos mais frequentes de variantes.
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49
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Umer M, Kalra DK. Cardiac MRI in Fabry disease. Front Cardiovasc Med 2023; 9:1075639. [PMID: 36818911 PMCID: PMC9931723 DOI: 10.3389/fcvm.2022.1075639] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/30/2022] [Indexed: 02/05/2023] Open
Abstract
Fabry disease is a rare, progressive X-linked inherited disorder of glycosphingolipid metabolism due to a deficiency of α-galactosidase A enzyme. It leads to the accumulation of globotriaosylceramide within lysosomes of multiple organs, predominantly the vascular, renal, cardiac, and nervous systems. Fabry cardiomyopathy is characterized by increased left ventricular wall thickness/mass, functional abnormalities, valvular heart disease, arrhythmias, and heart failure. Early diagnosis and treatment are critical to avoid cardiac or renal complications that can significantly reduce life expectancy in untreated FD. This review will focus on the role of cardiovascular magnetic resonance imaging in the diagnosis, clinical decision-making, and monitoring of treatment efficacy.
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50
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Gugelmo G, Vitturi N, Francini-Pesenti F, Fasan I, Lenzini L, Valentini R, Carraro G, Avogaro A, Spinella P. Gastrointestinal Manifestations and Low- FODMAP Protocol in a Cohort of Fabry Disease Adult Patients. Nutrients 2023; 15:nu15030658. [PMID: 36771363 PMCID: PMC9920936 DOI: 10.3390/nu15030658] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/15/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
Fabry disease (FD) is an X-linked lysosomal disorder caused by α-galactosidase A enzyme deficiency. Gastrointestinal (GI) manifestations are reported in FD with a prevalence of about 50%, usually treated by Enzymatic Replacement Therapy (ERT) or oral treatment. Since FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) can be involved in GI manifestations and dysbiosis in FD patients, a low-FODMAP diet could represent an alternative adjunctive treatment in FD subjects, as well as being useful for reducing symptoms in Irritable Bowel Syndrome (IBS). We retrospectively assessed data from 36 adult FD patients followed at the Inherited Metabolic Rare Diseases Adult Centre of the University Hospital of Padova (mean age 47.6 ± 16.2 years). Patients were screened for GI symptoms by IBS severity score and Gastrointestinal Symptom Rating Scale (GSRS) questionnaires. In symptomatic patients, the low-FODMAP diet was proposed in order to improve GI manifestations; it consists of a phase of elimination of fermentable saccharides, succeeded by a gradual reintegration of the same. Severe or moderate GI symptoms were found in 61.1% of patients, with no correlation to the therapy in use, and significantly more severe in the classical form of FD. The protocol was completed by seven patients affected by severe GI manifestations, significantly higher than the others. The low-FODMAP diet significantly improved indigestion, diarrhoea, and constipation. This dietetic protocol seemed to have a positive impact on intestinal symptoms, by identifying and reducing the intake of the foods most related to the onset of disorders and improving the clinical manifestations. A low-FODMAP diet may be an effective alternative approach to improve intestinal manifestations and quality of life, and nutrition can play an important role in the multidisciplinary care of patients with FD.
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Affiliation(s)
- Giorgia Gugelmo
- Division of Clinical Nutrition, Department of Medicine (DIMED), University Hospital, University of Padova, 35122 Padova, Italy
| | - Nicola Vitturi
- Division of Metabolic Diseases, Department of Medicine (DIMED), University Hospital, University of Padova, 35122 Padova, Italy
- Correspondence: ; Tel.: +39-049-821-4326
| | - Francesco Francini-Pesenti
- Division of Clinical Nutrition, Department of Medicine (DIMED), University Hospital, University of Padova, 35122 Padova, Italy
| | - Ilaria Fasan
- Division of Clinical Nutrition, Department of Medicine (DIMED), University Hospital, University of Padova, 35122 Padova, Italy
| | - Livia Lenzini
- Department of Medicine (DIMED), University Hospital, University of Padova, 35122 Padova, Italy
| | - Romina Valentini
- Division of Clinical Nutrition, Department of Medicine (DIMED), University Hospital, University of Padova, 35122 Padova, Italy
| | - Gianni Carraro
- Division of Nephrology, Department of Medicine (DIMED), University Hospital, University of Padova, 35122 Padova, Italy
| | - Angelo Avogaro
- Division of Metabolic Diseases, Department of Medicine (DIMED), University Hospital, University of Padova, 35122 Padova, Italy
| | - Paolo Spinella
- Division of Clinical Nutrition, Department of Medicine (DIMED), University Hospital, University of Padova, 35122 Padova, Italy
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