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García Sebastián C, Climent Payá V, Castillo JC, Urbano-Moral JÁ, Ruz Zafra A, Valle Caballero MJ, Zamorano JL. Prevalence of Fabry disease in patients with left ventricular hypertrophy and renal involvement (PrEFaCe). Med Clin (Barc) 2024:S0025-7753(24)00454-8. [PMID: 39198113 DOI: 10.1016/j.medcli.2024.06.009] [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: 04/15/2024] [Revised: 06/06/2024] [Accepted: 06/06/2024] [Indexed: 09/01/2024]
Abstract
INTRODUCTION AND AIMS Fabry disease (FD) causes glycosphingolipid accumulation in the vascular endothelium, with predominantly cardiac and renal involvement. Its prevalence in patients with concomitant involvement of these two organs is unknown. The objective of the study was to determine the prevalence of FD in patients with left ventricular hypertrophy and any degree of chronic kidney disease. PATIENTS AND METHODS Patients with ventricular thickness ≥13mm and kidney disease from 29 Spanish hospitals were included. Sociodemographic variables and target organ involvement of FD were collected. Laboratory determinations of EF were carried out, with an enzymatic activity test±genetic test in men and direct genetic test in women. RESULTS Eight hundred ninety-eight patients with left ventricular hypertrophy and chronic kidney disease were included. The presence of heart failure and cardiorenal syndrome was common (46.1% and 40.1%). Three patients (2 men and 1 woman) were diagnosed with FD, based on the presence of a pathogenic variant in the GLA gene and classic signs of FD, resulting in a prevalence of 0.33% (CI 95% 0.06-1%). Six patients (0.66%) presented genetic variants of unknown significance, without showing classic signs of FD, while in 13 patients (3.2%) performing the blood test was impossible. CONCLUSIONS FD is an important cause of left ventricular hypertrophy and chronic kidney disease. Genetic diagnosis is crucial for avoiding biases and ensuring accurate identification of FD, especially in women. The results support the inclusion of this disease in the differential diagnosis of patients with ventricular hypertrophy ≥13mm and chronic kidney disease.
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Affiliation(s)
- Cristina García Sebastián
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España.
| | - Vicente Climent Payá
- Servicio de Cardiología, Hospital General Universitario Dr. Balmis, Alicante, España; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
| | - Juan Carlos Castillo
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España; Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España
| | - José Ángel Urbano-Moral
- Unidad de Cardiopatías Hereditarias y Enfermedades del Miocardio; Hospital Universitario de Jaén, Jaén, España
| | | | | | - José Luis Zamorano
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España
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Mandler JM, Härtl J, Cordts I, Sturm M, Hedderich DM, Bafligil C, Baki E, Becker B, Machetanz G, Haack TB, Berthele A, Hemmer B, Deschauer M. Uncovering genetic mimics in multiple sclerosis: A single-center clinical exome sequencing study. Mult Scler J Exp Transl Clin 2024; 10:20552173241263491. [PMID: 39072298 PMCID: PMC11273569 DOI: 10.1177/20552173241263491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/05/2024] [Indexed: 07/30/2024] Open
Abstract
Background Multiple sclerosis (MS) shares clinical/radiological features with several monogenic diseases that can mimic MS. Objective We aimed to determine if exome sequencing can identify monogenic diseases in patients diagnosed with MS according to the McDonald criteria thus uncovering them as being misdiagnosed. Methods We performed whole exome sequencing in a cohort of 278 patients with MS, clinically or radiologically isolated syndrome without cerebrospinal fluid-specific oligoclonal bands (CSF-OCBs) (n = 228), a positive family history of MS (n = 44), or both (n = 6), thereby focusing on individuals potentially more likely to have underlying monogenic conditions mimicking MS. We prioritized 495 genes associated with monogenic diseases sharing features with MS. Results A disease-causing variant in NOTCH3 was identified in one patient without CSF-OCBs, no spinal lesions, with non-response to immunotherapy, and a family history of dementia, thereby converting the diagnosis to cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Moreover, 18 patients (6.5% of total) carried variants of unclear significance. Conclusion Monogenic diseases being misdiagnosed as MS seem rare in patients diagnosed with MS according to the McDonald criteria, even in CSF-OCB negative cases. The detected pathogenic NOTCH3 variant emphasizes CADASIL as a rare differential diagnosis and highlights the relevance of genetic testing in selected MS cases with atypical presentations.
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Affiliation(s)
- Julia M Mandler
- Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, München, Germany
| | - Johanna Härtl
- Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, München, Germany
| | - Isabell Cordts
- Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, München, Germany
| | - Marc Sturm
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Dennis M Hedderich
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, München, Germany
| | - Cemsel Bafligil
- Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, München, Germany
| | - Enayatullah Baki
- Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, München, Germany
| | - Benedikt Becker
- Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, München, Germany
| | - Gerrit Machetanz
- Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, München, Germany
| | - Tobias B Haack
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
- Centre for Rare Diseases, University of Tübingen, Tübingen, Germany
| | - Achim Berthele
- Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, München, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, München, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Marcus Deschauer
- Department of Neurology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, München, Germany
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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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Rekova P, Kovarova I, Uher T, Srpova B, Dostalova G, Linhart A, Vaneckova M, Stastna D. Missed diagnosis of Fabry disease: should we screen patients with multiple sclerosis? Neurol Sci 2024; 45:231-239. [PMID: 37480392 PMCID: PMC10761551 DOI: 10.1007/s10072-023-06962-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/11/2023] [Indexed: 07/24/2023]
Abstract
INTRODUCTION Fabry disease (FD) can be undiagnosed in the context of multiple sclerosis (MS) due to similar clinical and paraclinical features. Our study aimed to determine the prevalence (and the necessity of screening) of FD among patients with possible or definite MS. METHODS In this prospective monocentric observational study, we included consecutive patients enrolled between May 2017 and May 2019 after the first clinical event suggestive of MS. All patients underwent FD screening using dried blood spots in a stepwise manner combining genetic and enzyme testing. Patients were followed until May 2022. RESULTS We included 160 patients (73.1% female, mean age 33.9 years). The 2017 revised McDonald's criteria for definite MS were fulfilled by 74 (46.3%) patients at the time of study recruitment and 89 (55.6%) patients after 3-5 years of follow-up. None of the patients had a pathogenic GLA variant, and four (2.5%) had a variant of unknown significance (p.A143T, p.S126G, 2 × p.D313Y). In two of these patients, the intrathecal synthesis of oligoclonal bands was absent, and none had hyperproteinorachia or pleocytosis in cerebrospinal fluid. Detailed examination of FD organ manifestations revealed only discrete ocular and kidney involvement in two patients. CONCLUSION The prevalence of FD in the population of suspected or definite MS patients does not appear to be high. Our results do not support routine FD screening in all patients with a possible diagnosis of MS, but there is an urgent need to search for red flags and include FD in the differential diagnosis of MS.
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Affiliation(s)
- Petra Rekova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Ivana Kovarova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Tomas Uher
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Barbora Srpova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Gabriela Dostalova
- Second Department of Internal Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Ales Linhart
- Second Department of Internal Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
| | - Dominika Stastna
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia.
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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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