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Storck K, Stenzl A, Regenbogen C, Hofauer B, Knopf A. [Neuro-otological manifestations in Fabry disease-a retrospective single center study]. HNO 2024; 72:16-24. [PMID: 37747492 PMCID: PMC10781801 DOI: 10.1007/s00106-023-01360-4] [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] [Accepted: 08/04/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Fabry disease (FD) is one of the X‑linked lysosomal storage diseases that can affect any organ. They have a specific lysosomal dysfunction in common, which results in substrate accumulation in lysosomes instead of metabolite degradation. Due to the deficiency/absence of α‑galactosidase, globotriaosylceramides (Gb3) are deposited in lysosomes of the organs. In addition to acroparesthesia, angiokeratomas, autonomic dysfunction, vortex keratopathies, ischemic cerebral or cardiac complications and chronic renal failure, also vestibulocochlear dysfunctions with sudden or progressive asymmetric hearing loss, tinnitus and vertigo may be observed. PATIENTS AND METHODS In this retrospective study, 33 patients (men = 16 and women = 17) with FD were evaluated. All patients presented to us in interdisciplinary cooperation as part of routine examinations by the specialized center for lysosomal storage diseases of the in-house department of nephrology. This presentation is carried out as a screening examination independent of neuro-otological symptoms. RESULTS The mean age at diagnosis was 34.76 (±11.55) years. The first presentation in our ENT department was at 40.45 (±11.71) years. We were able to demonstrate a significant correlation between neurological symptoms or apoplexy and hearing loss (p = 0.001) and between cardiac manifestations and hearing loss (p = 0.024). CONCLUSION Hearing loss is a potential symptom of Fabry disease and is not limited to the classic male phenotype. Due to possible positive correlations with neurological and cardiological manifestations of the disease, routine ENT screening examinations should be carried out to be able to identify and treat neuro-otological deficits at an early stage. In addition, FD should also be considered and tested as a differential diagnosis, especially in younger patients with sudden unilateral or bilateral hearing loss and a family history.
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Affiliation(s)
- Katharina Storck
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar, TU München, München, Deutschland.
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland.
| | - Anna Stenzl
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar, TU München, München, Deutschland
| | - Claudia Regenbogen
- Innere Medizin II, Nephrologie, Klinikum rechts der Isar, TU München, München, Deutschland
| | - Benedikt Hofauer
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar, TU München, München, Deutschland
| | - Andreas Knopf
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universität Freiburg, Freiburg, Deutschland
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Zhao Y, Zhu Y, Li F, Sun Y, Ma W, Wu Y, Zhang W, Wang Z, Yuan Y, Huang Y. Brain MRI correlations with disease burden and biomarkers in Fabry disease. J Neurol 2023; 270:4939-4948. [PMID: 37356023 PMCID: PMC10511580 DOI: 10.1007/s00415-023-11826-8] [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: 04/04/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To quantitatively evaluate cerebral small vessel disease (CSVD) in brain magnetic resonance imaging (MRI) and its correlation with disease burden and markers in Fabry disease, a rare X-linked lysosomal storage disease. METHODS We collected brain MRI data from seventy-one Chinese patients with Fabry disease. CSVD was evaluated using an age-related white matter change rating scale, Fazekas scale, enlarged perivascular spaces grading scale, lacunar infarction scale, Microbleed Anatomical Rating Scale, global cortical atrophy scale, and small-vessel disease score. Factors associated with MRI lesions, including sex, clinical subtype, disease severity, disease burden, genotype, and biomarkers, were also analyzed. RESULTS Of 71 patients, 16 (22.5%) experienced ischemic stroke. The incidences of lacunar infarctions, white matter hyperintensities, and cerebral microbleeds were 55%, 62%, and 33%, respectively. The abnormal MRI group had later disease onset, longer disease duration, and a higher Mainz Severity Score Index (p < 0.05) than the normal MRI group. Patients with more severe clinical phenotypes also had higher CVSD-related scores. Sex and GLA mutational type were not closely associated with brain MRI lesions. Of the disease markers, the Mainz Severity Score Index and plasma globotriaosylsphingosine (Lyso-Gb3) were closely correlated with the majority of the MRI scores, whereas α-galactosidase A activity was not. CONCLUSION Brain MRI revealed progressive lacunar infarctions, white matter hyperintensities, and decreased brain volume in patients with Fabry disease. Brain MRI lesions were closely related to onset-age; disease duration, severity, burden; and plasma Lyso-Gb3. However, they were not associated with sex, α-galactosidase A activity, or GLA mutation type.
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Affiliation(s)
- Yawen Zhao
- Department of Neurology, Peking University First Hospital, Xishiku Street, West District, Beijing, 100034, China
| | - Ying Zhu
- Department of Medical Iconography, Peking University First Hospital, Beijing, China
| | - Fan Li
- Department of Neurology, Peking University First Hospital, Xishiku Street, West District, Beijing, 100034, China
| | - Yunchuang Sun
- Department of Neurology, Peking University First Hospital, Xishiku Street, West District, Beijing, 100034, China
| | - Wei Ma
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yuan Wu
- Department of Ophtalmology, Peking University First Hospital, Beijing, China
| | - Wei Zhang
- Department of Neurology, Peking University First Hospital, Xishiku Street, West District, Beijing, 100034, China.
- Beijing Key Laboratory of Neurovascular Diseases, Beijing, China.
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, Xishiku Street, West District, Beijing, 100034, China
- Beijing Key Laboratory of Neurovascular Diseases, Beijing, China
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital, Xishiku Street, West District, Beijing, 100034, China
- Beijing Key Laboratory of Neurovascular Diseases, Beijing, China
| | - Yining Huang
- Department of Neurology, Peking University First Hospital, Xishiku Street, West District, Beijing, 100034, China
- Beijing Key Laboratory of Neurovascular Diseases, Beijing, China
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Köroğlu EY, Gökçay Canpolat A, Yılmaz S, Demir Ö. What Is the Role of Sensorineural Hearing Loss in Fabry Disease Screening? Turk Arch Otorhinolaryngol 2023; 61:52-57. [PMID: 37727814 PMCID: PMC10506525 DOI: 10.4274/tao.2023.2023-3-10] [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: 04/10/2023] [Accepted: 08/04/2023] [Indexed: 09/21/2023] Open
Abstract
Objective Fabry disease is a rare hereditary lysosomal storage disease caused by the deficiency of alpha-galactosidase A (α-GLA). Although sensorineural hearing loss is common in Fabry disease, there are no studies in the literature that have screened a population with sensorineural hearing loss for Fabry disease. In this study, we aimed to screen a group of patients who were diagnosed with sensorineural hearing loss and underwent a hearing test for Fabry disease. Methods One hundred sixty eight patients who were aged 18-75 years and diagnosed with idiopathic hearing loss between July 2019 and January 2020 were included. In male patients, α-GLA enzyme activity was analyzed. Patients with low enzyme activity were identified and genetic testing was performed for mutations in the GLA gene. In females, only genetic testing was performed. Results Eighty four women and 84 men were included in the study. α-GLA enzyme activity was low in 11 of the 84 male patients (13%). One out of these 11 patients had a gene mutation for Fabry disease. Moreover, four relatives of this index patient were diagnosed with Fabry disease in family screening. GLA gene mutation was also found in one of the 84 female patients. Consequently, two (1.2%) of our 168 patients were diagnosed with Fabry disease by screening with enzyme activity and genetic testing. Conclusion Our study showed that screening for Fabry disease in patients with idiopathic sensorineural hearing loss without other specific findings might be a useful strategy for detecting new cases.
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Affiliation(s)
- Ekin Yiğit Köroğlu
- Department of Internal Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Asena Gökçay Canpolat
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Suna Yılmaz
- Department of Audiology, Ankara University Faculty of Health Sciences, Ankara, Turkey
| | - Özgür Demir
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
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Yazdanfard PDW, Effraimidis G, Madsen CV, Nielsen LH, Rasmussen ÅK, Petersen JH, Sørensen SS, Køber L, de Abreu VHF, Larsen VA, Feldt-Rasmussen U. Hearing loss in fabry disease: A 16 year follow-up study of the Danish nationwide cohort. Mol Genet Metab Rep 2022; 31:100841. [PMID: 35242579 PMCID: PMC8857513 DOI: 10.1016/j.ymgmr.2022.100841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 10/27/2022] Open
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Cochleovestibular involvement in patients with Fabry disease: data from the multicenter cohort FFABRY. Eur Arch Otorhinolaryngol 2021; 279:1639-1644. [PMID: 34825971 DOI: 10.1007/s00405-021-07173-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 11/03/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE Fabry disease (FD) is a lysosomal storage disease responsible for cochleovestibular involvement. Exact prevalence and pathophysiological mechanisms behind ENT affections are still poorly known. Treating FD with enzyme replacement therapy (ERT) does not seem to significantly improve the ENT symptoms, while the impact of migalastat has yet to be determined. METHODS We carried out a retrospective multi-centre study on 47 patients from the FFABRY cohort who had an ENT consultation in the context of their FD. The information collected were as follows: clinical examination, videonystagmoscopy, pure-tone speech audiometry, videonystagmography or VHIT (Video Head Impulse Test). Severe hearing loss was defined as greater than 70 dB. RESULTS The median age of our cohort was 52 years with a non-negligible proportion of non-classic variants and female carriers. 72.3% of the patients complained of at least one of the following symptoms: hearing loss, tinnitus or vertigo. Pure-tone audiometry was abnormal in 61.7% of the patients (29/47), while speech audiometry was abnormal for 41.7% of the patients. The age of the patients and hypertrophic cardiomyopathy were significantly associated with the existence of an anomaly in pure-tone audiometry results. Severe hearing loss (> 70 dB) was significantly more common in male patients. DISCUSSION Hearing loss is particularly frequent in FD and is not limited to classic phenotypes. Close ENT follow-up is essential for Fabry patients to detect those who might benefit from hearing aid. Further studies are needed to define the impact of migalastat on cochleovestibular symptoms.
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Becherucci F, Landini S, Cirillo L, Mazzinghi B, Romagnani P. Look Alike, Sound Alike: Phenocopies in Steroid-Resistant Nephrotic Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8363. [PMID: 33198123 PMCID: PMC7696007 DOI: 10.3390/ijerph17228363] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/30/2020] [Accepted: 11/10/2020] [Indexed: 12/11/2022]
Abstract
Steroid-resistant nephrotic syndrome (SRNS) is a clinical picture defined by the lack of response to standard steroid treatment, frequently progressing toward end-stage kidney disease. The genetic basis of SRNS has been thoroughly explored since the end of the 1990s and especially with the advent of next-generation sequencing. Genetic forms represent about 30% of cases of SRNS. However, recent evidence supports the hypothesis that "phenocopies" could account for a non-negligible fraction of SRNS patients who are currently classified as non-genetic, paving the way for a more comprehensive understanding of the genetic background of the disease. The identification of phenocopies is mandatory in order to provide patients with appropriate clinical management and to inform therapy. Extended genetic testing including phenocopy genes, coupled with reverse phenotyping, is recommended for all young patients with SRNS to avoid unnecessary and potentially harmful diagnostic procedures and treatment, and for the reclassification of the disease. The aim of this work is to review the main steps of the evolution of genetic testing in SRNS, demonstrating how a paradigm shifting from "forward" to "reverse" genetics could significantly improve the identification of the molecular mechanisms of the disease, as well as the overall clinical management of affected patients.
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Affiliation(s)
- Francesca Becherucci
- Pediatric Nephrology and Dialysis Unit, Meyer Children’s Hospital, Viale Pieraccini 24, 50139 Florence, Italy; (L.C.); (B.M.); (P.R.)
| | - Samuela Landini
- Department of Biomedical, Experimental and Clinical Science “Mario Serio”, University of Florence, Viale Morgagni 50, 50134 Florence, Italy;
| | - Luigi Cirillo
- Pediatric Nephrology and Dialysis Unit, Meyer Children’s Hospital, Viale Pieraccini 24, 50139 Florence, Italy; (L.C.); (B.M.); (P.R.)
- Department of Biomedical, Experimental and Clinical Science “Mario Serio”, University of Florence, Viale Morgagni 50, 50134 Florence, Italy;
| | - Benedetta Mazzinghi
- Pediatric Nephrology and Dialysis Unit, Meyer Children’s Hospital, Viale Pieraccini 24, 50139 Florence, Italy; (L.C.); (B.M.); (P.R.)
| | - Paola Romagnani
- Pediatric Nephrology and Dialysis Unit, Meyer Children’s Hospital, Viale Pieraccini 24, 50139 Florence, Italy; (L.C.); (B.M.); (P.R.)
- Department of Biomedical, Experimental and Clinical Science “Mario Serio”, University of Florence, Viale Morgagni 50, 50134 Florence, Italy;
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Landini S, Mazzinghi B, Becherucci F, Allinovi M, Provenzano A, Palazzo V, Ravaglia F, Artuso R, Bosi E, Stagi S, Sansavini G, Guzzi F, Cirillo L, Vaglio A, Murer L, Peruzzi L, Pasini A, Materassi M, Roperto RM, Anders HJ, Rotondi M, Giglio SR, Romagnani P. Reverse Phenotyping after Whole-Exome Sequencing in Steroid-Resistant Nephrotic Syndrome. Clin J Am Soc Nephrol 2019; 15:89-100. [PMID: 31831576 PMCID: PMC6946071 DOI: 10.2215/cjn.06060519] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 10/08/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Nephrotic syndrome is a typical presentation of genetic podocytopathies but occasionally other genetic nephropathies can present as clinically indistinguishable phenocopies. We hypothesized that extended genetic testing followed by reverse phenotyping would increase the diagnostic rate for these patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS All patients diagnosed with nephrotic syndrome and referred to our center between 2000 and 2018 were assessed in this retrospective study. When indicated, whole-exome sequencing and in silico filtering of 298 genes related to CKD were combined with subsequent reverse phenotyping in patients and families. Pathogenic variants were defined according to current guidelines of the American College of Medical Genetics. RESULTS A total of 111 patients (64 steroid-resistant and 47 steroid-sensitive) were included in the study. Not a single pathogenic variant was detected in the steroid-sensitive group. Overall, 30% (19 out of 64) of steroid-resistant patients had pathogenic variants in podocytopathy genes, whereas a substantial number of variants were identified in other genes, not commonly associated with isolated nephrotic syndrome. Reverse phenotyping, on the basis of a personalized diagnostic workflow, permitted to identify previously unrecognized clinical signs of an unexpected underlying genetic nephropathy in a further 28% (18 out of 64) of patients. These patients showed similar multidrug resistance, but different long-term outcome, when compared with genetic podocytopathies. CONCLUSIONS Reverse phenotyping increased the diagnostic accuracy in patients referred with the diagnosis of steroid-resistant nephrotic syndrome.
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Affiliation(s)
- Samuela Landini
- Medical Genetics Unit, Meyer Children's University Hospital, Florence, Italy.,Department of Clinical and Experimental Biomedical Sciences "Mario Serio,".,Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), and
| | - Benedetta Mazzinghi
- Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy
| | - Francesca Becherucci
- Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy
| | - Marco Allinovi
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio,".,Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), and
| | - Aldesia Provenzano
- Medical Genetics Unit, Meyer Children's University Hospital, Florence, Italy.,Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), and
| | - Viviana Palazzo
- Medical Genetics Unit, Meyer Children's University Hospital, Florence, Italy
| | - Fiammetta Ravaglia
- Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy
| | - Rosangela Artuso
- Medical Genetics Unit, Meyer Children's University Hospital, Florence, Italy
| | - Emanuele Bosi
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio,"
| | - Stefano Stagi
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Giulia Sansavini
- Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy
| | - Francesco Guzzi
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio,".,Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), and.,Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy
| | - Luigi Cirillo
- Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy
| | - Augusto Vaglio
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio,".,Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), and.,Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy
| | - Luisa Murer
- Pediatric Nephrology Dialysis and Transplant Unit, Department of Pediatrics, University of Padua, Padua, Italy
| | - Licia Peruzzi
- Pediatric Nephrology Unit, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Andrea Pasini
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Marco Materassi
- Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy
| | - Rosa Maria Roperto
- Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy
| | - Hans-Joachim Anders
- Medizinische Klinik and Poliklinik IV, Klinikum der Ludwig Maximilians University (LMU) München, München, Germany; and
| | - Mario Rotondi
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), University of Pavia, Pavia, Italy
| | - Sabrina Rita Giglio
- Medical Genetics Unit, Meyer Children's University Hospital, Florence, Italy.,Department of Clinical and Experimental Biomedical Sciences "Mario Serio,".,Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), and
| | - Paola Romagnani
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio," .,Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), and.,Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy
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Yazdanfard PD, Madsen CV, Nielsen LH, Rasmussen ÅK, Petersen JH, Seth A, Sørensen SS, Køber L, Feldt-Rasmussen U. Significant hearing loss in Fabry disease: Study of the Danish nationwide cohort prior to treatment. PLoS One 2019; 14:e0225071. [PMID: 31809513 PMCID: PMC6897399 DOI: 10.1371/journal.pone.0225071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/27/2019] [Indexed: 11/21/2022] Open
Abstract
Background Fabry disease (FD) is a lysosomal storage disorder resulting in systemic accumulation of globotriaosylceramide resulting in multi-organ dysfunction e.g. cerebral, cardiac, renal and audiologic complications. The audiologic involvement in FD has often been neglected; while not a lethal aspect of the disease, hearing loss can have a significantly negative impact on quality of life. Objectives To investigate baseline hearing status of the Danish Fabry cohort prior to treatment, compared to sex- and age-expected hearing levels and correlating hearing to renal and cerebral findings. Material and methods Retrospective study of baseline hearing status of the Danish Fabry cohort (n = 83, 9–72 years). Air conduction and speech discrimination scores were assessed at 6 frequencies between 0.25–8 kHz bilaterally. Data were collected between 2001–2014 and compiled in STATA using multilinear mixed modelling for statistical evaluation. Results Hearing thresholds at all frequencies deviated from the expected thresholds of an otologically normal cohort (p<0.001) and ranged 0.5 to 1.5 standard deviations below expected values. In total 29 males and 54 females were included. Hearing loss was more pronounced in the higher frequencies. There was a trend of association between hearing loss and measured glomerular filtration rate (mGFR) (p = 0.084). No association was present between hearing loss and albuminuria (p = 0.90), Fabry related cerebral abnormalities (p = 0.84) and cardiac left ventricular mass index, (LVMi) (p = 0.67) independent of sex. Hearing thresholds were poorer for men compared to women (p = 0.001). Sex differences were present at 0.25, 4 and 8 kHz. Conclusion Our findings demonstrated significant hearing loss in Danish FD patients before treatment initiation, being more profound than in otologically healthy individuals at all frequencies. Additionally, we observed no association between hearing loss and LVMi, albuminuria or FD cerebral abnormalities, with a trend of association to mGFR. Synopsis Patients with Fabrys disease have hearing loss of all frequencies and most prominently at high frequencies (4–8 kHz), with no association between the hearing loss and cerebral abnormalities, and cardiac mass but with a trend of association to measured glomerular filtration rate.
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Affiliation(s)
- Puriya Daniel Yazdanfard
- Department of Medical Endocrinology, Copenhagen University Hospital (Rigshospitalet), Copenhagen University, Copenhagen, Denmark
| | - Christoffer Valdorff Madsen
- Department of Medical Endocrinology, Copenhagen University Hospital (Rigshospitalet), Copenhagen University, Copenhagen, Denmark
| | - Lars Holme Nielsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital (Rigshospitalet), Copenhagen University, Copenhagen, Denmark
| | - Åse Krogh Rasmussen
- Department of Medical Endocrinology, Copenhagen University Hospital (Rigshospitalet), Copenhagen University, Copenhagen, Denmark
| | - Jørgen Holm Petersen
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Alka Seth
- Department of Radiology, Copenhagen University Hospital (Rigshospitalet), Copenhagen University, Copenhagen, Denmark
| | - Søren Schwartz Sørensen
- Department of Nephrology, Copenhagen University Hospital (Rigshospitalet), Copenhagen University, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital (Rigshospitalet), Copenhagen University, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology, Copenhagen University Hospital (Rigshospitalet), Copenhagen University, Copenhagen, Denmark
- * E-mail:
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Wang F, Yamamoto H, Yoshida T, Sugimoto S, Teranishi M, Tsuboi K, Sone M. Otological aspects of Fabry disease in patients with normal hearing. NAGOYA JOURNAL OF MEDICAL SCIENCE 2019; 81:469-475. [PMID: 31579337 PMCID: PMC6728203 DOI: 10.18999/nagjms.81.3.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We investigated the otological aspects of Fabry disease (FD) in patients with normal hearing. Forty-one patients (21 men, 20 women) with bilaterally normal hearing were recruited, and their otological symptoms and hearing evaluations, which included pure tone audiometry (PTA) and distortion product otoacoustic emission (DPOAE), were investigated. Ten of the 21 male (47.6%) and eight of the 20 female (40.0%) patients had otological symptoms, of which tinnitus was the most frequent. Cardiac dysfunction was more frequently observed in female patients. The average thresholds on PTA were below 25 dB at all frequencies, but DPOAE amplitudes were significantly lower in female patients at some frequencies. Otological symptoms were frequently observed in patients with FD, despite their normal hearing levels on PTA. DPOAE might provide useful information regarding cochlear disturbances related to the disease..
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Affiliation(s)
- Fei Wang
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Otorhinolaryngology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Hiroshi Yamamoto
- Department of Otorhinolaryngology, Nagoya Central Hospital, Nagoya, Japan
| | - Tadao Yoshida
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satofumi Sugimoto
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaaki Teranishi
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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10
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Köping M, Shehata-Dieler W, Schneider D, Cebulla M, Oder D, Müntze J, Nordbeck P, Wanner C, Hagen R, Schraven SP. Characterization of vertigo and hearing loss in patients with Fabry disease. Orphanet J Rare Dis 2018; 13:137. [PMID: 30111353 PMCID: PMC6094894 DOI: 10.1186/s13023-018-0882-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 07/29/2018] [Indexed: 01/05/2023] Open
Abstract
Background Fabry Disease (FD) is an X-linked hereditary lysosomal storage disorder which leads to a multisystemic intralysosomal accumulation of globotriaosylceramid (Gb3). Besides prominent renal and cardiac organ involvement, patients commonly complain about vestibulocochlear symptoms like high-frequency hearing loss, tinnitus and vertigo. However, comprehensive data especially on vertigo remain scarce. The aim of this study was to examine the prevalence and characteristics of vertigo and hearing loss in patients with FD, depending on renal and cardiac parameters and get hints about the site and the pattern of the lesions. Methods Single-center study with 57 FD patients. Every patient underwent an oto-rhino-laryngological examination as well as videonystagmography and vestibular evoked myogenic potentials (VEMPs) and audiological measurements using pure tone audiometry and auditory brainstem response audiometry (ABR). Renal function was measured by eGFR, cardiac impairment was graduated by NYHA class. Results More than one out of three patients (35.1%) complained about hearing loss, 54.4% about vertigo and 28.1% about both symptom. In 74% a sensorineural hearing loss of at least 25 dB was found, ABR could exclude any retrocochlear lesion. Caloric testing showed abnormal values in 71.9%, VEMPs were pathological in 68%. A correlation between the side or the shape of hearing loss and pathological vestibular testing could not be revealed. Conclusions Hearing loss and vertigo show a high prevalence in FD. While hearing loss seems due to a cochlear lesion, peripheral vestibular as well as central nervous pathologies cause vertigo. Thus, both the site of lesion and the pathophysiological patterns seem to differ. Electronic supplementary material The online version of this article (10.1186/s13023-018-0882-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria Köping
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Comprehensive Hearing Center (CHC) and Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital Würzburg, Josef-Schneider-Straße 11, Haus B2, D-97080, Würzburg, Germany.
| | - Wafaa Shehata-Dieler
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Comprehensive Hearing Center (CHC) and Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital Würzburg, Josef-Schneider-Straße 11, Haus B2, D-97080, Würzburg, Germany
| | - Dieter Schneider
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Comprehensive Hearing Center (CHC) and Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital Würzburg, Josef-Schneider-Straße 11, Haus B2, D-97080, Würzburg, Germany
| | - Mario Cebulla
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Comprehensive Hearing Center (CHC) and Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital Würzburg, Josef-Schneider-Straße 11, Haus B2, D-97080, Würzburg, Germany
| | - Daniel Oder
- Department of Internal Medicine I, Comprehensive Heart Failure Center (CHFC) and Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital Würzburg, Oberdürrbacher Straße 6, D-97080, Würzburg, Germany
| | - Jonas Müntze
- Department of Internal Medicine I, Comprehensive Heart Failure Center (CHFC) and Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital Würzburg, Oberdürrbacher Straße 6, D-97080, Würzburg, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, Comprehensive Heart Failure Center (CHFC) and Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital Würzburg, Oberdürrbacher Straße 6, D-97080, Würzburg, Germany
| | - Christoph Wanner
- Department of Internal Medicine I, Comprehensive Heart Failure Center (CHFC) and Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital Würzburg, Oberdürrbacher Straße 6, D-97080, Würzburg, Germany
| | - Rudolf Hagen
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Comprehensive Hearing Center (CHC) and Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital Würzburg, Josef-Schneider-Straße 11, Haus B2, D-97080, Würzburg, Germany
| | - Sebastian P Schraven
- Department of Otorhinolaryngology, Head and Neck Surgery "Otto Körner", University Medical Center Rostock, Doberaner Straße 137-139, D-18057, Rostock, Germany
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Oder D, Liu D, Üçeyler N, Sommer C, Hu K, Salinger T, Müntze J, Petritsch B, Ertl G, Wanner C, Nordbeck P, Weidemann F. Clinical impact of the alpha-galactosidase A gene single nucleotide polymorphism -10C>T: A single-center observational study. Medicine (Baltimore) 2018; 97:e10669. [PMID: 29794742 PMCID: PMC6392711 DOI: 10.1097/md.0000000000010669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Single nucleotide polymorphisms (SNPs) in the alpha-galactosidase A gene region (GLA) have been discussed as potential cause of symptoms and organ manifestations similarly to those seen in Fabry disease (FD). However, due to scarce data, clinical implications remain limited. The aim of the present study was to investigate the clinical impact of -10C>T SNP in the GLA.Prospective single-center observational study to determine the natural history and outcome of FD.Subjects initially referred to the Fabry Center for Interdisciplinary Therapy Würzburg (FAZIT) for management of suspected FD (11 women, 2 men, mean age 42 ± 10 years) who were tested negative for coding GLA mutations but positive for the noncoding -10C>T SNP underwent comprehensive characterization for therapy recommendation.All subjects reported at least 1 neurological, but no cardiac or renal symptoms. In 7 patients, pain of unknown etiology was reported and 3 patients had a history of cryptogenic stroke. In all patients, α-GAL activity was at a lower limit, ranging between 0.27 and 0.45 nmol/min per mg protein (reference: 0.4-1.0), while plasma Lyso-Gb3 levels remained normal (range 0.39 ± 0.33; reference: ≤0.9 ng/mL). For both hemizygous subjects investigated, brain magnetic resonance imaging revealed unspecific white matter lesions. One of these subjects had suffered from severe early-onset stroke, the other showed mild hypertrophic cardiomyopathy.Presence of isolated heterozygous -10C >T SNP is not associated with clinically relevant symptoms or organ manifestations as seen in FD. Respective polymorphisms might, however, play a role in modifying disease severity in FD. Great care has to be taken in respective subjects suspected to suffer from nonclassical FD in order to prevent unnecessary Fabry-specific therapy.
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Affiliation(s)
- Daniel Oder
- Department of Internal Medicine I, Division of Cardiology and Nephrology and Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg
- Fabry Center for Interdisciplinary Therapy, University of Würzburg
| | - Dan Liu
- Department of Internal Medicine I, Division of Cardiology and Nephrology and Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg
| | - Nurcan Üçeyler
- Fabry Center for Interdisciplinary Therapy, University of Würzburg
- Department of Neurology, University Hospital Würzburg
| | - Claudia Sommer
- Fabry Center for Interdisciplinary Therapy, University of Würzburg
- Department of Neurology, University Hospital Würzburg
| | - Kai Hu
- Department of Internal Medicine I, Division of Cardiology and Nephrology and Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg
- Fabry Center for Interdisciplinary Therapy, University of Würzburg
| | - Tim Salinger
- Department of Internal Medicine I, Division of Cardiology and Nephrology and Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg
- Fabry Center for Interdisciplinary Therapy, University of Würzburg
| | - Jonas Müntze
- Department of Internal Medicine I, Division of Cardiology and Nephrology and Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg
- Fabry Center for Interdisciplinary Therapy, University of Würzburg
| | - Bernhard Petritsch
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg
| | - Georg Ertl
- Department of Internal Medicine I, Division of Cardiology and Nephrology and Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg
| | - Christoph Wanner
- Department of Internal Medicine I, Division of Cardiology and Nephrology and Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg
- Fabry Center for Interdisciplinary Therapy, University of Würzburg
| | - Peter Nordbeck
- Department of Internal Medicine I, Division of Cardiology and Nephrology and Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg
- Fabry Center for Interdisciplinary Therapy, University of Würzburg
| | - Frank Weidemann
- Department of Internal Medicine I, Division of Cardiology and Nephrology and Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg
- Fabry Center for Interdisciplinary Therapy, University of Würzburg
- Department of Medicine II, Katharinen-Hospital Unna, Unna, Germany
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