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Spinelli L, Bianco A, Riccio E, Pisani A, Iaccarino G. Cardiac involvement in Anderson-Fabry disease. The role of advanced echocardiography. Front Cardiovasc Med 2024; 11:1440636. [PMID: 39314767 PMCID: PMC11417619 DOI: 10.3389/fcvm.2024.1440636] [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: 05/29/2024] [Accepted: 08/19/2024] [Indexed: 09/25/2024] Open
Abstract
Anderson-Fabry disease (AFD) is a lysosomal storage disorder, depending on defects in alpha galactosidase A activity, due to a mutation in the galactosidase alpha gene. Cardiovascular involvement represents the leading cause of death in AFD. Cardiac imaging plays a key role in the evaluation and management of AFD patients. Echocardiography is the first-line imaging modality for the identification of the typical features of AFD cardiomyopathy. Advanced echocardiography that allows assessment of myocardial deformation has provided insights into the cardiac functional status of AFD patients. The present review highlights the value and the perspectives of advanced ultrasound imaging in AFD.
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Affiliation(s)
- Letizia Spinelli
- Interdepartmental Research Center for Hypertension and Related Conditions, University of Naples, Naples, Italy
| | - Antonio Bianco
- Department of Public Health, Federico II University, Naples, Italy
| | - Eleonora Riccio
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Antonio Pisani
- Department of Public Health, Federico II University, Naples, Italy
| | - Guido Iaccarino
- Interdepartmental Research Center for Hypertension and Related Conditions, University of Naples, Naples, Italy
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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2
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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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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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4
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Roy A, Cumberland MJ, O'Shea C, Holmes A, Kalla M, Gehmlich K, Geberhiwot T, Steeds RP. Arrhythmogenesis in Fabry Disease. Curr Cardiol Rep 2024; 26:545-560. [PMID: 38607539 PMCID: PMC11199244 DOI: 10.1007/s11886-024-02053-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE OF REVIEW Fabry Disease (FD) is a rare lysosomal storage disorder characterised by multiorgan accumulation of glycosphingolipid due to deficiency in the enzyme α-galactosidase A. Cardiac sphingolipid accumulation triggers various types of arrhythmias, predominantly ventricular arrhythmia, bradyarrhythmia, and atrial fibrillation. Arrhythmia is likely the primary contributor to FD mortality with sudden cardiac death, the most frequent cardiac mode of death. Traditionally FD was seen as a storage cardiomyopathy triggering left ventricular hypertrophy, diastolic dysfunction, and ultimately, systolic dysfunction in advanced disease. The purpose of this review is to outline the current evidence exploring novel mechanisms underlying the arrhythmia substrate. RECENT FINDINGS There is growing evidence that FD cardiomyopathy is a primary arrhythmic disease with each stage of cardiomyopathy (accumulation, hypertrophy, inflammation, and fibrosis) contributing to the arrhythmia substrate via various intracellular, extracellular, and environmental mechanisms. It is therefore important to understand how these mechanisms contribute to an individual's risk of arrhythmia in FD. In this review, we outline the epidemiology of arrhythmia, pathophysiology of arrhythmogenesis, risk stratification, and cardiac therapy in FD. We explore how advances in conventional cardiac investigations performed in FD patients including 12-lead electrocardiography, transthoracic echocardiography, and cardiac magnetic resonance imaging have enabled early detection of pro-arrhythmic substrate. This has allowed for appropriate risk stratification of FD patients. This paves the way for future work exploring the development of therapeutic initiatives and risk prediction models to reduce the burden of arrhythmia.
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Affiliation(s)
- Ashwin Roy
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
- Department of Cardiology, University Hospital Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK.
| | - Max J Cumberland
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Christopher O'Shea
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Andrew Holmes
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Manish Kalla
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Cardiology, University Hospital Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
| | - Katja Gehmlich
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Division of Cardiovascular Medicine, Department of Medicine and British Heart Foundation Centre of Research Excellence Oxford, University of Oxford, Oxford, UK
| | - Tarekegn Geberhiwot
- Department of Inherited Metabolic Diseases, University Hospital Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
- Institute of Metabolism and System Research, University of Birmingham, Birmingham, UK
| | - Richard P Steeds
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Cardiology, University Hospital Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
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5
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Douglas CM, Bird JE, Kopinke D, Esser KA. An optimized approach to study nanoscale sarcomere structure utilizing super-resolution microscopy with nanobodies. PLoS One 2024; 19:e0300348. [PMID: 38687705 PMCID: PMC11060602 DOI: 10.1371/journal.pone.0300348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/23/2024] [Indexed: 05/02/2024] Open
Abstract
The sarcomere is the fundamental contractile unit in skeletal muscle, and the regularity of its structure is critical for function. Emerging data demonstrates that nanoscale changes to the regularity of sarcomere structure can affect the overall function of the protein dense ~2μm sarcomere. Further, sarcomere structure is implicated in many clinical conditions of muscle weakness. However, our understanding of how sarcomere structure changes in disease, especially at the nanoscale, has been limited in part due to the inability to robustly detect and measure at sub-sarcomere resolution. We optimized several methodological steps and developed a robust pipeline to analyze sarcomere structure using structured illumination super-resolution microscopy in conjunction with commercially-available and fluorescently-conjugated Variable Heavy-Chain only fragment secondary antibodies (nanobodies), and achieved a significant increase in resolution of z-disc width (353nm vs. 62nm) compared to confocal microscopy. The combination of these methods provides a unique approach to probe sarcomere protein localization at the nanoscale and may prove advantageous for analysis of other cellular structures.
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Affiliation(s)
- Collin M. Douglas
- Department of Physiology and Aging, University of Florida, Gainesville, Florida, United States of America
| | - Jonathan E. Bird
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, Florida, United States of America
| | - Daniel Kopinke
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, Florida, United States of America
| | - Karyn A. Esser
- Department of Physiology and Aging, University of Florida, Gainesville, Florida, United States of America
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Pieroni M, Namdar M, Olivotto I, Desnick RJ. Anderson-Fabry disease management: role of the cardiologist. Eur Heart J 2024; 45:1395-1409. [PMID: 38486361 DOI: 10.1093/eurheartj/ehae148] [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: 09/03/2023] [Revised: 02/04/2024] [Accepted: 02/27/2024] [Indexed: 04/22/2024] Open
Abstract
Anderson-Fabry disease (AFD) is a lysosomal storage disorder characterized by glycolipid accumulation in cardiac cells, associated with a peculiar form of hypertrophic cardiomyopathy (HCM). Up to 1% of patients with a diagnosis of HCM indeed have AFD. With the availability of targeted therapies for sarcomeric HCM and its genocopies, a timely differential diagnosis is essential. Specifically, the therapeutic landscape for AFD is rapidly evolving and offers increasingly effective, disease-modifying treatment options. However, diagnosing AFD may be difficult, particularly in the non-classic phenotype with prominent or isolated cardiac involvement and no systemic red flags. For many AFD patients, the clinical journey from initial clinical manifestations to diagnosis and appropriate treatment remains challenging, due to late recognition or utter neglect. Consequently, late initiation of treatment results in an exacerbation of cardiac involvement, representing the main cause of morbidity and mortality, irrespective of gender. Optimal management of AFD patients requires a dedicated multidisciplinary team, in which the cardiologist plays a decisive role, ranging from the differential diagnosis to the prevention of complications and the evaluation of timing for disease-specific therapies. The present review aims to redefine the role of cardiologists across the main decision nodes in contemporary AFD clinical care and drug discovery.
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Affiliation(s)
- Maurizio Pieroni
- Cardiovascular Department, San Donato Hospital, Via Pietro Nenni 22, 52100 Arezzo, Italy
| | - Mehdi Namdar
- Cardiology Division, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi Hospital and Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Robert J Desnick
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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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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Weissman D, Dudek J, Sequeira V, Maack C. Fabry Disease: Cardiac Implications and Molecular Mechanisms. Curr Heart Fail Rep 2024; 21:81-100. [PMID: 38289538 PMCID: PMC10923975 DOI: 10.1007/s11897-024-00645-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE OF REVIEW This review explores the interplay among metabolic dysfunction, oxidative stress, inflammation, and fibrosis in Fabry disease, focusing on their potential implications for cardiac involvement. We aim to discuss the biochemical processes that operate in parallel to sphingolipid accumulation and contribute to disease pathogenesis, emphasizing the importance of a comprehensive understanding of these processes. RECENT FINDINGS Beyond sphingolipid accumulation, emerging studies have revealed that mitochondrial dysfunction, oxidative stress, and chronic inflammation could be significant contributors to Fabry disease and cardiac involvement. These factors promote cardiac remodeling and fibrosis and may predispose Fabry patients to conduction disturbances, ventricular arrhythmias, and heart failure. While current treatments, such as enzyme replacement therapy and pharmacological chaperones, address disease progression and symptoms, their effectiveness is limited. Our review uncovers the potential relationships among metabolic disturbances, oxidative stress, inflammation, and fibrosis in Fabry disease-related cardiac complications. Current findings suggest that beyond sphingolipid accumulation, other mechanisms may significantly contribute to disease pathogenesis. This prompts the exploration of innovative therapeutic strategies and underscores the importance of a holistic approach to understanding and managing Fabry disease.
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Affiliation(s)
- David Weissman
- Department of Translational Research, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, Haus A15, 97078, Würzburg, Germany
| | - Jan Dudek
- Department of Translational Research, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, Haus A15, 97078, Würzburg, Germany
| | - Vasco Sequeira
- Department of Translational Research, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, Haus A15, 97078, Würzburg, Germany
| | - Christoph Maack
- Department of Translational Research, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, Haus A15, 97078, Würzburg, Germany.
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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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10
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Liu T, Li X, Wang Y, Zhou M, Liang F. Computational modeling of electromechanical coupling in human cardiomyocyte applied to study hypertrophic cardiomyopathy and its drug response. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 231:107372. [PMID: 36736134 DOI: 10.1016/j.cmpb.2023.107372] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/02/2023] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND OBJECTIVE Knowledge of electromechanical coupling in cardiomyocyte and how it is influenced by various pathophysiological factors is fundamental to understanding the pathogenesis of myocardial disease and its response to medication, which is however hard to be thoroughly addressed by clinical/experimental studies due to technical limitations. At this point, computational modeling offers an alternative approach. The main objective of the study was to develop a computational model capable of simulating the process of electromechanical coupling and quantifying the roles of various factors in play in the human left ventricular cardiomyocyte. METHODS A new electrophysiological model was firstly built by combining several existing electrophysiological models and incorporating the mechanism of electrophysiological homeostasis, which was subsequently coupled to models representing the cross-bridge dynamics and active force generation during excitation-contraction coupling and the passive mechanical properties of cardiomyocyte to yield an integrative electromechanical model. Model parameters were calibrated or optimized based on a large amount of experimental data. The resulting model was applied to delineate the characteristics of electromechanical coupling and explore underlying determinant factors in hypertrophic cardiomyopathy (HCM) cardiomyocyte, as well as quantify their changes in response to different medications. RESULTS Model predictions captured the major electromechanical characteristics of cardiomyocyte under both normal physiological and HCM conditions. In comparison with normal cardiomyocyte, HCM cardiomyocyte suffered from systemic changes in both electrophysiological and mechanical variables. Numerical simulations of drug response revealed that Mavacamten and Metoprolol could both reduce the active contractility and alleviate calcium overload but had marked differential influences on many other electromechanical variables, which theoretically explained why the two drugs have differential therapeutic effects. In addition, our numerical experiments demonstrated the important role of compensatory ion transport in maintaining electrophysiological homeostasis and regulating cytoplasmic volume. CONCLUSIONS A sophisticated computational model has the advantage of providing quantitative and integrative insights for understanding the pathogenesis and drug responses of HCM or other myocardial diseases at the level of cardiomyocyte, and hence may contribute as a useful complement to clinical/experimental studies. The model may also be coupled to tissue- or organ-level models to strengthen the physiological implications of macro-scale numerical simulations.
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Affiliation(s)
- Taiwei Liu
- Department of Engineering Mechanics, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, 800 Dong Chuan Road, Shanghai 200240, China
| | - Xuanyu Li
- Department of Engineering Mechanics, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, 800 Dong Chuan Road, Shanghai 200240, China
| | - Yue Wang
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Mi Zhou
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Fuyou Liang
- Department of Engineering Mechanics, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, 800 Dong Chuan Road, Shanghai 200240, China; State Key Laboratory of Ocean Engineering, Shanghai Jiao Tong University, Shanghai 200240, China; World-Class Research Center "Digital biodesign and personalized healthcare", Sechenov First Moscow State Medical University, Moscow 19991, Russia.
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11
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El Sayed M, Postema PG, Datema M, van Dussen L, Kors JA, ter Haar CC, Bleijendaal H, Galenkamp H, van den Born BJH, Hollak CEM, Langeveld M. ECG Changes during Adult Life in Fabry Disease: Results from a Large Longitudinal Cohort Study. Diagnostics (Basel) 2023; 13:diagnostics13030354. [PMID: 36766461 PMCID: PMC9913957 DOI: 10.3390/diagnostics13030354] [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: 11/13/2022] [Revised: 01/07/2023] [Accepted: 01/14/2023] [Indexed: 01/21/2023] Open
Abstract
Background: Fabry disease (FD) is an X-linked, lysosomal storage disorder leading to severe cardiomyopathy in a significant proportion of patients. To identify ECG markers that reflect early cardiac involvement and disease progression, we conducted a long term retrospective study in a large cohort of FD patients. Methods: A total of 1995 ECGs from 133 patients with classical FD (64% females, 80% treated with enzyme replacement therapy), spanning 20 years of follow-up, were compared to ECGs from 3893 apparently healthy individuals. Generalized linear mixed models were used to evaluate the effect of age, FD and sex on: P-wave duration, PR-interval, QRS-duration, QTc, Cornell index, spatial QRS-T angle and frontal QRS-axis. Regression slopes and absolute values for each parameter were compared between FD patients and control subjects. Results: At a younger age (<40 years), the Cornell index was higher and frontal QRS-axis more negative in FD patients compared to controls (p < 0.05). For the other ECG parameters, the rate of change, more than the absolute value, was greater in FD patients compared to controls (p < 0.05). From the fifth decade (men) or sixth (women) onwards, absolute values for P-wave duration, QRS-duration, QTc and spatial QRS-T angle were longer and higher in FD patients compared to control subjects. Conclusions: ECG abnormalities indicative of FD are age and sex dependent. Tracking the rate of change in ECG parameters could be a good way to detect disease progression, guiding treatment initiation. Moreover, monitoring ECG changes in FD can be used to evaluate the effectiveness of treatment.
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Affiliation(s)
- Mohamed El Sayed
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology and Metabolism, Inborn Errors of Metabolism, 1105 AZ Amsterdam, The Netherlands
| | - Pieter G. Postema
- Department of Cardiology, Heart Center, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, 1105 AZ Amsterdam, The Netherlands
| | - Mareen Datema
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology and Metabolism, Inborn Errors of Metabolism, 1105 AZ Amsterdam, The Netherlands
| | - Laura van Dussen
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology and Metabolism, Inborn Errors of Metabolism, 1105 AZ Amsterdam, The Netherlands
| | - Jan A. Kors
- Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Cato C. ter Haar
- Department of Cardiology, Heart Center, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, 1105 AZ Amsterdam, The Netherlands
| | - Hidde Bleijendaal
- Department of Cardiology, Heart Center, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, 1105 AZ Amsterdam, The Netherlands
- Department of Biostatistics & Bioinformatics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, Health Behaviors and Chronic Diseases, 1105 AZ Amsterdam, The Netherlands
| | - Bert-Jan H. van den Born
- Amsterdam Public Health, Health Behaviors and Chronic Diseases, 1105 AZ Amsterdam, The Netherlands
- Department of Vascular Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes, 1105 AZ Amsterdam, The Netherlands
| | - Carla E. M. Hollak
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology and Metabolism, Inborn Errors of Metabolism, 1105 AZ Amsterdam, The Netherlands
| | - Mirjam Langeveld
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology and Metabolism, Inborn Errors of Metabolism, 1105 AZ Amsterdam, The Netherlands
- Correspondence: ; Tel.: +31-20-5663578; Fax: +31-20-6917682
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12
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An Overview of Molecular Mechanisms in Fabry Disease. Biomolecules 2022; 12:biom12101460. [PMID: 36291669 PMCID: PMC9599883 DOI: 10.3390/biom12101460] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 12/24/2022] Open
Abstract
Fabry disease (FD) (OMIM #301500) is a rare genetic lysosomal storage disorder (LSD). LSDs are characterized by inappropriate lipid accumulation in lysosomes due to specific enzyme deficiencies. In FD, the defective enzyme is α-galactosidase A (α-Gal A), which is due to a mutation in the GLA gene on the X chromosome. The enzyme deficiency leads to a continuous deposition of neutral glycosphingolipids (globotriaosylceramide) in the lysosomes of numerous tissues and organs, including endothelial cells, smooth muscle cells, corneal epithelial cells, renal glomeruli and tubules, cardiac muscle and ganglion cells of the nervous system. This condition leads to progressive organ failure and premature death. The increasing understanding of FD, and LSD in general, has led in recent years to the introduction of enzyme replacement therapy (ERT), which aims to slow, if not halt, the progression of the metabolic disorder. In this review, we provide an overview of the main features of FD, focusing on its molecular mechanism and the role of biomarkers.
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13
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Pieroni M, Ciabatti M, Graziani F, Camporeale A, Saletti E, Lillo R, Figliozzi S, Bolognese L. The Heart in Fabry Disease: Mechanisms Beyond Storage and Forthcoming Therapies. Rev Cardiovasc Med 2022; 23:196. [PMID: 39077177 PMCID: PMC11273771 DOI: 10.31083/j.rcm2306196] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/29/2022] [Accepted: 04/13/2022] [Indexed: 07/31/2024] Open
Abstract
In patients with Fabry disease (FD), cardiovascular involvement is the main cause of death and reduction of quality of life. Left ventricular hypertrophy mimicking hypertrophic cardiomyopathy is the main feature of FD cardiac involvement although glycolipid storage occurs in all cardiac cellular types. Accumulation of lysosomal globotriasylceramide represents the main mechanism of cardiac damage in early stages, but secondary pathways of cellular and tissue damage, triggered by lysosomal storage, and including altered energy production, inflammation and cell death, contribute to cardiac damage and disease progression. These mechanisms appear prominent in more advanced stages, hampering and reducing the efficacy of FD-specific treatments. Therefore, additional cardiovascular therapies are important to manage cardiovascular symptoms and reduce cardiovascular events. Although new therapies targeting lysosomal storage are in development, a better definition and comprehension of the complex pathophysiology of cardiac damage in FD, may lead to identify new therapeutic targets beyond storage and new therapeutic strategies.
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Affiliation(s)
- Maurizio Pieroni
- Cardiovascular Department, San Donato Hospital, 52100 Arezzo, Italy
| | - Michele Ciabatti
- Cardiovascular Department, San Donato Hospital, 52100 Arezzo, Italy
| | - Francesca Graziani
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Antonia Camporeale
- Multimodality Cardiac Imaging Unit, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Elisa Saletti
- Cardiovascular Department, San Donato Hospital, 52100 Arezzo, Italy
| | - Rosa Lillo
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Stefano Figliozzi
- Clinical Echocardiography Diagnostic Service, Cardio Center, Humanitas Research Hospital IRCCS, 20089 Rozzano, Italy
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14
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Figliozzi S, Camporeale A, Boveri S, Pieruzzi F, Pieroni M, Lusardi P, Spada M, Mignani R, Burlina A, Graziani F, Pica S, Tondi L, Bernardini A, Chow K, Namdar M, Lombardi M. ECG-based score estimates the probability to detect Fabry Disease cardiac involvement. Int J Cardiol 2021; 339:110-117. [PMID: 34274410 DOI: 10.1016/j.ijcard.2021.07.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/18/2021] [Accepted: 07/08/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To elaborate an ECG-based nomogram estimating the probability to detect cardiac involvement by cardiac magnetic resonance (CMR) in Fabry Disease (FD). METHODS 119 FD patients and 26 healthy controls underwent ECG and CMR. Test (n = 88, 60%) and validation cohorts (n = 57, 40%) were randomly derived. Cardiac involvement was defined as the presence of low myocardial T1 value, a CMR-surrogate of myocardial glycosphingolipid storage. ECG changes associated with low T1 value were identified in the test cohort, included in the nomogram and then tested in the validation cohort. RESULTS Sokolow-Lyon index (AUC = 0.769), ratio between P-wave and PR-segment durations (Pwave/PRsegment) (AUC = 0.778), QRS duration (AUC = 0.703), QT (AUC = 0.769) duration were independently associated with the presence of low T1 on CMR at multivariate analysis. An ECG-based nomogram including these four parameters was accurate in identifying patients with CMR evidence of glycosphingolipid storage (c-index of the derived-nomogram = 0.90 in the test group; 0.81 in the validation group). CONCLUSION We propose a practical ECG-based nomogram accurately estimating the probability to detect low T1 values by CMR in FD patients. The application of this tool in clinical practice could improve early detection of FD cardiac involvement.
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Affiliation(s)
- Stefano Figliozzi
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, S. Luca Hospital, Milan 20149, Italy; Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
| | - Antonia Camporeale
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
| | - Sara Boveri
- Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
| | - Federico Pieruzzi
- Department of Medicine and Surgery, University of Milano Bicocca, Nephrology and Dialysis Unit, ASST-Monza San Gerardo Hospital, Monza, Italy.
| | | | - Paola Lusardi
- Department of Cardiology, Humanitas Hospital, Torino, Italy
| | - Marco Spada
- Department of Pediatrics, University of Torino, Torino, Italy.
| | - Renzo Mignani
- Nephrology and Dialysis Department, Infermi Hospital, Rimini, Italy.
| | | | - Francesca Graziani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Silvia Pica
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
| | - Lara Tondi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
| | - Andrea Bernardini
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Kelvin Chow
- Siemens Medical Solutions USA, Inc., Chicago, United States.
| | - Mehdi Namdar
- Cardiology Division, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.
| | - Massimo Lombardi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
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15
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Spinelli L, Imbriaco M, Giugliano G, Nappi C, Gaudieri V, Riccio E, Pisani A, Trimarco B, Cuocolo A. Focal reduction in left ventricular 123I-metaiodobenzylguanidine uptake and impairment in systolic function in patients with Anderson-Fabry disease. J Nucl Cardiol 2021; 28:641-649. [PMID: 31087266 DOI: 10.1007/s12350-019-01734-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/21/2019] [Accepted: 04/15/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Abnormalities of cardiac sympathetic innervation have been demonstrated in Anderson-Fabry disease (AFD). We aimed to investigate the relationship between regional left ventricular (LV) denervation and regional function abnormalities. METHODS Twenty-four AFD patients (43.7 ± 12.8 years) were studied by 123I-metaiodobenzylguanidine (MIBG) cardiac imaging and speckle-tracking echocardiography. Segmental tracer uptake was estimated according to 0 to 4 score, and total defect score (TDS) was calculated for each patient. RESULTS Segmental longitudinal strain worsened as MIBG uptake score increased (P < 0.001). By ROC analysis, a segmental longitudinal strain > - 16.2% predicted a segmental MIBG uptake score ≥1, with 79.7% sensitivity and 65.3% specificity. Segmental MIBG uptake defects were found in 13 out 24 AFD patients. LV mass index (60.8 ± 10.1 vs. 41.4 ± 9.8 g/h2.7), relative wall thickness (0.51 ± 0.06 vs. 0.40 ± 0.06), systolic pulmonary artery pressure (35.2 ± 6.7 vs. 27.2 ± 4.2 mmHg), and longitudinal strain (- 14.3 ± 2.7 vs. -19.4 ± 1.8%) were significantly higher in patients with segmental defect (all P < 0.01). At multivariate linear regression analysis, global longitudinal strain was independently associated with TDS (B = 3.007, 95% confidence interval 1.384 to 4.630, P = 0.001). CONCLUSIONS Reduced cardiac MIBG uptake reflects the severity of cardiac involvement in AFD patients. LV longitudinal function impairment seems to be an earlier disease feature than regional myocardial denervation.
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Affiliation(s)
- Letizia Spinelli
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy.
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Giuseppe Giugliano
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Eleonora Riccio
- Department of Public Health, Nephrology Unit, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Antonio Pisani
- Department of Public Health, Nephrology Unit, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131, Naples, Italy
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16
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Cardiac Involvement in Fabry Disease: JACC Review Topic of the Week. J Am Coll Cardiol 2021; 77:922-936. [PMID: 33602475 DOI: 10.1016/j.jacc.2020.12.024] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/11/2020] [Indexed: 12/22/2022]
Abstract
Fabry disease (FD) is a rare X-linked inherited lysosomal storage disorder caused by deficient α-galactosidase A activity that leads to an accumulation of globotriasylceramide (Gb3) in affected tissues, including the heart. Cardiovascular involvement usually manifests as left ventricular hypertrophy, myocardial fibrosis, heart failure, and arrhythmias, which limit quality of life and represent the most common causes of death. Following the introduction of enzyme replacement therapy, early diagnosis and treatment have become essential to slow disease progression and prevent major cardiac complications. Recent advances in the understanding of FD pathophysiology suggest that in addition to Gb3 accumulation, other mechanisms contribute to the development of Fabry cardiomyopathy. Progress in imaging techniques have improved diagnosis and staging of FD-related cardiac disease, suggesting a central role for myocardial inflammation and setting the stage for further research. In addition, with the recent approval of oral chaperone therapy and new treatment developments, the FD-specific treatment landscape is rapidly evolving.
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17
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Abstract
Fabry disease (FD) is a rare X-linked hereditary disorder (Xq22) caused by a deficiency in alpha-galactosidase activity. A 34-year-old man was referred to our hospital because of renal dysfunction. He had previously undergone pacemaker implantation at 24 years of age. Investigations revealed undetectable alpha-galactosidase A activity levels. Renal biopsy results indicated vacuolization of podocytes. A genetic analysis revealed that the patient carried the W340X mutation. Enzyme replacement therapy with agalsidase beta was started. This case is novel because most cases of FD nephropathy precede cardiac disease. In our patient, the cardiac event was the initial event, and renal impairment followed.
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Affiliation(s)
- Yuji Kato
- Department of Nephrology, Japanese Red Cross Ishinomaki Hospital, Japan
| | - Ayako Ishikawa
- Department of Internal Medicine, Tohoku Kosai Hospital, Japan
| | - Satoshi Aoki
- Department of Nephrology, Japanese Red Cross Ishinomaki Hospital, Japan
| | - Hiroyuki Sato
- Department of Nephrology, Japanese Red Cross Ishinomaki Hospital, Japan
| | - Yoshie Ojima
- Department of Nephrology, Japanese Red Cross Ishinomaki Hospital, Japan
| | - Saeko Kagaya
- Department of Nephrology, Hypertension and Endocrinology, Tohoku University School of Medicine, Japan
| | - Tasuku Nagasawa
- Department of Nephrology, Hypertension and Endocrinology, Tohoku University School of Medicine, Japan
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18
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Birket MJ, Raibaud S, Lettieri M, Adamson AD, Letang V, Cervello P, Redon N, Ret G, Viale S, Wang B, Biton B, Guillemot JC, Mikol V, Leonard JP, Hanley NA, Orsini C, Itier JM. A Human Stem Cell Model of Fabry Disease Implicates LIMP-2 Accumulation in Cardiomyocyte Pathology. Stem Cell Reports 2019; 13:380-393. [PMID: 31378672 PMCID: PMC6700557 DOI: 10.1016/j.stemcr.2019.07.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 01/19/2023] Open
Abstract
Here, we have used patient-derived induced pluripotent stem cell (iPSC) and gene-editing technology to study the cardiac-related molecular and functional consequences of mutations in GLA causing the lysosomal storage disorder Fabry disease (FD), for which heart dysfunction is a major cause of mortality. Our in vitro model recapitulated clinical data with FD cardiomyocytes accumulating GL-3 and displaying an increased excitability, with altered electrophysiology and calcium handling. Quantitative proteomics enabled the identification of >5,500 proteins in the cardiomyocyte proteome and secretome, and revealed accumulation of the lysosomal protein LIMP-2 and secretion of cathepsin F and HSPA2/HSP70-2 in FD. Genetic correction reversed these changes. Overexpression of LIMP-2 directly induced the secretion of cathepsin F and HSPA2/HSP70-2, implying causative relationship, and led to massive vacuole accumulation. In summary, our study has revealed potential new cardiac biomarkers for FD, and provides valuable mechanistic insight into the earliest pathological events in FD cardiomyocytes.
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Affiliation(s)
- Matthew J Birket
- Sanofi, Translational Sciences Unit, Sanofi, 13 quai Jules Guesdes, 94400 Vitry-sur-Seine, France; Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, The University of Manchester, Oxford Road, Manchester M13 9PT, UK.
| | - Sophie Raibaud
- Sanofi, Translational Sciences Unit, Avenue Pierre Brossolette, 91380 Chilly-Mazarin, France
| | - Miriam Lettieri
- Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, The University of Manchester, Oxford Road, Manchester M13 9PT, UK
| | - Antony D Adamson
- Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, The University of Manchester, Oxford Road, Manchester M13 9PT, UK
| | - Valerie Letang
- Sanofi, Translational Sciences Unit, Avenue Pierre Brossolette, 91380 Chilly-Mazarin, France
| | - Pauline Cervello
- Sanofi, Translational Sciences Unit, Avenue Pierre Brossolette, 91380 Chilly-Mazarin, France
| | - Nicolas Redon
- Sanofi, Translational Sciences Unit, Avenue Pierre Brossolette, 91380 Chilly-Mazarin, France
| | - Gwenaelle Ret
- Sanofi, Translational Sciences Unit, Sanofi, 13 quai Jules Guesdes, 94400 Vitry-sur-Seine, France
| | - Sandra Viale
- Sanofi, Translational Sciences Unit, Sanofi, 13 quai Jules Guesdes, 94400 Vitry-sur-Seine, France
| | - Bing Wang
- Sanofi, GBD-Analytical R&D, 211 Second Avenue, Waltham, MA 02451, USA
| | - Bruno Biton
- Sanofi, Translational Sciences Unit, Avenue Pierre Brossolette, 91380 Chilly-Mazarin, France
| | - Jean-Claude Guillemot
- Sanofi, Translational Sciences Unit, Avenue Pierre Brossolette, 91380 Chilly-Mazarin, France
| | - Vincent Mikol
- Sanofi, Translational Sciences Unit, Avenue Pierre Brossolette, 91380 Chilly-Mazarin, France
| | - John P Leonard
- Sanofi, Rare Disease Science Unit, 153 Second Avenue, Waltham, MA 02451, USA
| | - Neil A Hanley
- Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, The University of Manchester, Oxford Road, Manchester M13 9PT, UK; Endocrinology Department, Manchester University NHS Foundation Trust, Grafton Street, Manchester M13 9WU, UK
| | - Cecile Orsini
- Sanofi, Translational Sciences Unit, Sanofi, 13 quai Jules Guesdes, 94400 Vitry-sur-Seine, France
| | - Jean-Michel Itier
- Sanofi, Translational Sciences Unit, Sanofi, 13 quai Jules Guesdes, 94400 Vitry-sur-Seine, France.
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19
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van Mil A, Balk GM, Neef K, Buikema JW, Asselbergs FW, Wu SM, Doevendans PA, Sluijter JPG. Modelling inherited cardiac disease using human induced pluripotent stem cell-derived cardiomyocytes: progress, pitfalls, and potential. Cardiovasc Res 2018; 114:1828-1842. [PMID: 30169602 PMCID: PMC6887927 DOI: 10.1093/cvr/cvy208] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/06/2018] [Accepted: 08/28/2018] [Indexed: 12/17/2022] Open
Abstract
In the past few years, the use of specific cell types derived from induced pluripotent stem cells (iPSCs) has developed into a powerful approach to investigate the cellular pathophysiology of numerous diseases. Despite advances in therapy, heart disease continues to be one of the leading causes of death in the developed world. A major difficulty in unravelling the underlying cellular processes of heart disease is the extremely limited availability of viable human cardiac cells reflecting the pathological phenotype of the disease at various stages. Thus, the development of methods for directed differentiation of iPSCs to cardiomyocytes (iPSC-CMs) has provided an intriguing option for the generation of patient-specific cardiac cells. In this review, a comprehensive overview of the currently published iPSC-CM models for hereditary heart disease is compiled and analysed. Besides the major findings of individual studies, detailed methodological information on iPSC generation, iPSC-CM differentiation, characterization, and maturation is included. Both, current advances in the field and challenges yet to overcome emphasize the potential of using patient-derived cell models to mimic genetic cardiac diseases.
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Affiliation(s)
- Alain van Mil
- Division Heart and Lungs, Department of Cardiology, Experimental Cardiology Laboratory, Regenerative Medicine Center, University Medical Center Utrecht, Internal Mail No G03.550, GA Utrecht, the Netherlands
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Geerthe Margriet Balk
- Division Heart and Lungs, Department of Cardiology, Experimental Cardiology Laboratory, Regenerative Medicine Center, University Medical Center Utrecht, Internal Mail No G03.550, GA Utrecht, the Netherlands
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Klaus Neef
- Division Heart and Lungs, Department of Cardiology, Experimental Cardiology Laboratory, Regenerative Medicine Center, University Medical Center Utrecht, Internal Mail No G03.550, GA Utrecht, the Netherlands
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jan Willem Buikema
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Folkert W Asselbergs
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Faculty of Population Health Sciences, Institute of Cardiovascular Science, University College London, London, UK
- Durrer Center for Cardiovascular Research, Netherlands Heart Institute, Utrecht, the Netherlands
- Farr Institute of Health Informatics Research and Institute of Health Informatics, University College London, London, UK
| | - Sean M Wu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Pieter A Doevendans
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Joost P G Sluijter
- Division Heart and Lungs, Department of Cardiology, Experimental Cardiology Laboratory, Regenerative Medicine Center, University Medical Center Utrecht, Internal Mail No G03.550, GA Utrecht, the Netherlands
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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20
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Aguiar P, Azevedo O, Pinto R, Marino J, Cardoso C, Sousa N, Cunha D, Hughes D, Ducla Soares JL. Biomarkers of Myocardial Fibrosis: Revealing the Natural History of Fibrogenesis in Fabry Disease Cardiomyopathy. J Am Heart Assoc 2018. [PMID: 29535138 PMCID: PMC5907540 DOI: 10.1161/jaha.117.007124] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Cardiomyopathy is a major determinant of overall Fabry disease (FD) prognosis, with the worst outcomes in patients with myocardial fibrosis. Late gadolinium enhancement is currently the gold standard for evaluation of replacement myocardial fibrosis; however, this event is irreversible, thus identification of biomarkers of earlier diffuse fibrosis is paramount. Methods and Results Type I collagen synthesis and degradation biomarkers (PICP [carboxyterminal propeptide of procollagen type I], ICTP [carboxyterminal telopeptide of type I collagen], and MMP1 [matrix metalloproteinase 1] and MMP2) and markers of bone synthesis and degradation were evaluated (to adjust type I collagen metabolism to bone turnover) in FD patients and controls. FD patients were grouped by cardiomyopathy severity, according to echocardiogram: (1) normal, (2) tissue Doppler abnormalities, (3) left ventricular hypertrophy. A significant increase in PICP and a significant decrease in matrix metalloproteinases were observed in FD patients; even the group with normal echocardiogram had a significant increase in PICP. We also found a significant correlation between left ventricular mass and PICP (ρ=0.378, P=0.003) and MMP1 (ρ=−0.484, P<0.001). PICP (adjusted for bone turnover) was the better predictor of left ventricular mass in multivariable regression, and its diagnostic accuracy to predict late gadolinium enhancement was also significant. Conclusions Collagen type I synthesis is increased in FD cardiomyopathy, even in the earlier stages of the disease, and this profibrotic state has good predictive value for and is likely to be critical to the development of overt left ventricular hypertrophy. Moreover, inhibition of enzymes involved in collagen type I cleavage also seems crucial to myocardial collagen deposition.
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Affiliation(s)
- Patrício Aguiar
- Medicine 1 Department, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Olga Azevedo
- Cardiology Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rui Pinto
- JCS. Dr Joaquim Chaves, Lab Análises Clínicas, Miraflores, Portugal
| | - Jacira Marino
- Lysosomal Storage Disorders Unit, Royal Free London NHS Foundation Trust and University College London, London, United Kingdom
| | - Carlos Cardoso
- JCS. Dr Joaquim Chaves, Lab Análises Clínicas, Miraflores, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Damião Cunha
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Derralynn Hughes
- Lysosomal Storage Disorders Unit, Royal Free London NHS Foundation Trust and University College London, London, United Kingdom
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Nelson BC, Hashem SI, Adler ED. Human-Induced Pluripotent Stem Cell-Based Modeling of Cardiac Storage Disorders. Curr Cardiol Rep 2017; 19:26. [PMID: 28251514 DOI: 10.1007/s11886-017-0829-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW The aim of this study is to review the published human-induced pluripotent stem cell-derived cardiomyocyte (hiPSC-CM) models of cardiac storage disorders and to evaluate the limitations and future applications of this technology. RECENT FINDINGS Several cardiac storage disorders (CSDs) have been modeled using patient-specific hiPSC-CMs, including Anderson-Fabry disease, Danon disease, and Pompe disease. These models have shown that patient-specific hiPSC-CMs faithfully recapitulate key phenotypic features of CSDs and respond predictably to pharmacologic manipulation. hiPSC-CMs generated from patients with CSDs are representative models of the patient disease state and can be used as an in vitro system for the study of human cardiomyocytes. While these models suffer from several limitations, they are likely to play an important role in future mechanistic studies of cardiac storage disorders and the development of targeted therapeutics for these diseases.
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Affiliation(s)
- Bradley C Nelson
- Department of Medicine, Division of Cardiology, University of California San Diego, 9500 Gilman Drive, Biomedical Research Facility, Room 1217 AA, La Jolla, CA, 92093, USA
| | - Sherin I Hashem
- Department of Medicine, Division of Cardiology, University of California San Diego, 9500 Gilman Drive, Biomedical Research Facility, Room 1217 AA, La Jolla, CA, 92093, USA
| | - Eric D Adler
- Department of Medicine, Division of Cardiology, University of California San Diego, 9500 Gilman Drive, Biomedical Research Facility, Room 1217 AA, La Jolla, CA, 92093, USA.
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Frustaci A, Chimenti C, Doheny D, Desnick RJ. Evolution of cardiac pathology in classic Fabry disease: Progressive cardiomyocyte enlargement leads to increased cell death and fibrosis, and correlates with severity of ventricular hypertrophy. Int J Cardiol 2017; 248:257-262. [PMID: 28688718 DOI: 10.1016/j.ijcard.2017.06.079] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/15/2017] [Accepted: 06/20/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fabry disease, an X-linked lysosomal storage disease, results from deficient α-galactosidase A (α-GalA) activity and the systemic accumulation of α-galactosyl-terminated glycosphingolipids. Two major phenotypes, "Classic" and "Later-Onset", lead to renal failure, and/or cardiac disease, and early demise. To date, the evolution and progression of the cardiac pathology and resultant clinical manifestations in family members of phenotype have not been well characterized. METHODS AND RESULTS In a Classic family with nine affected members (GLA mutation c.983delG), cardiac imaging, angiography, and cardiac biopsies were performed in four males and two heterozygous females. Tissues were examined histologically, ultrastructurally, and myocardial necrosis and apoptosis were evaluated by in situ ligation with hairpin probes. Increasing cardiac pathology correlated with ECG and cardiac magnetic resonance findings. Young affected males with "pre-hypertrophy" had 18-20μm cardiomyocyte diameters, <30% vacuolar areas in myocytes, and normal levels of necrosis and apoptosis. Patients with "moderate hypertrophy" (maximal wall thickness (MWT) ≤16mm) had 30-35μm cardiomyocyte diameters, ~45% vacuolar areas, and moderate levels of necrosis and apoptosis. In contrast, the oldest male with severe hypertrophy (MWT=21mm) had 38-40μm cell diameters, >60% vacuolar areas, and marked necrosis and apoptosis. CONCLUSION Progressive gender-specific cardiac pathology and clinical manifestations were documented in affected Classic family members. Increasing cardiomyocyte diameter was correlated with disease severity, age, and gender. Fibrosis was presumably caused by cell death of enlarged, substrate-engorged cardiomyocytes. These results support early enzyme therapy in Classic males to prevent/minimize irreversible cardiac damage.
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Affiliation(s)
- Andrea Frustaci
- Department of Cardiovascular, Respiratory, Nephrologic, Geriatric and Anesthesiologic Sciences, La Sapienza University, Rome, Italy
| | - Cristina Chimenti
- Department of Cardiovascular, Respiratory, Nephrologic, Geriatric and Anesthesiologic Sciences, La Sapienza University, Rome, Italy
| | - Dana Doheny
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Robert J Desnick
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
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Spinelli L, Pellegrino T, Pisani A, Giudice CA, Riccio E, Imbriaco M, Salvatore M, Trimarco B, Cuocolo A. Relationship between left ventricular diastolic function and myocardial sympathetic denervation measured by 123I-meta-iodobenzylguanidine imaging in Anderson-Fabry disease. Eur J Nucl Med Mol Imaging 2015; 43:729-39. [DOI: 10.1007/s00259-015-3273-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/27/2015] [Indexed: 12/31/2022]
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Chimenti C, Scopelliti F, Vulpis E, Tafani M, Villanova L, Verardo R, De Paulis R, Russo MA, Frustaci A. Increased oxidative stress contributes to cardiomyocyte dysfunction and death in patients with Fabry disease cardiomyopathy. Hum Pathol 2015; 46:1760-8. [PMID: 26362204 DOI: 10.1016/j.humpath.2015.07.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/17/2015] [Accepted: 07/15/2015] [Indexed: 11/24/2022]
Abstract
Cardiac dysfunction of Fabry disease (FD) has been associated with myofilament damage and cell death as result of α-galactosidase A deficiency and globotriaosylceramide accumulation. We sought to evaluate the role of oxidative stress in FD cardiomyocyte dysfunction. Myocardial tissue from 18 patients with FD was investigated for the expression of inducible nitric oxide synthase (iNOS) and nitrotyrosine by immunohistochemistry. Western blot analysis for nitrotyrosine was also performed. Oxidative damage to DNA was investigated by immunostaining for 8-hydroxydeoxyguanosine (8-OHdG), whereas apoptosis was evaluated by in situ ligation with hairpin probes. iNOS and nitrotyrosine expression was increased in FD hearts compared with hypertrophic cardiomyopathy and normal controls. Remarkably, immunostaining was homogeneously expressed in FD male cardiomyocytes, whereas it was only detected in the affected cardiomyocytes of FD females. Western blot analysis confirmed an increase in FD cardiomyocyte protein nitration compared with controls. 8-OHdG was expressed in 25% of cardiomyocyte nuclei from FD patients, whereas it was absent in controls. The intensity of immunostaining for iNOS/nitrotyrosine correlated with 8-OHdG expression in cardiomyocyte nuclei. Apoptosis of FD cardiomyocytes was 187-fold higher than in controls, and apoptotic nuclei were positive for 8-OHdG. Cardiac dysfunction of FD reflects increased myocardial nitric oxide production with oxidative damage of cardiomyocyte myofilaments and DNA, causing cell dysfunction and death.
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Affiliation(s)
- Cristina Chimenti
- Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences Department, La Sapienza University, Rome, Italy 00166; IRCCS L. Spallanzani, Rome, Italy 00149
| | - Fernanda Scopelliti
- Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences Department, La Sapienza University, Rome, Italy 00166
| | | | - Marco Tafani
- Experimental Medicine and Pathology Department, La Sapienza University, Rome, Italy 00166
| | - Lidia Villanova
- Experimental Medicine and Pathology Department, La Sapienza University, Rome, Italy 00166
| | | | | | | | - Andrea Frustaci
- Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences Department, La Sapienza University, Rome, Italy 00166; IRCCS L. Spallanzani, Rome, Italy 00149.
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Frustaci A, Morgante E, Russo MA, Scopelliti F, Grande C, Verardo R, Franciosa P, Chimenti C. Pathology and Function of Conduction Tissue in Fabry Disease Cardiomyopathy. Circ Arrhythm Electrophysiol 2015; 8:799-805. [DOI: 10.1161/circep.114.002569] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 05/21/2015] [Indexed: 11/16/2022]
Abstract
Background—
Cardiac arrhythmias are common in Fabry disease (FD) and may occur in prehypertrophic cardiomyopathy suggesting an early compromise of conduction tissue (CT). Therefore, FD X-linked and CT may be variously involved in male and female patients with FD cardiomyopathy, affecting CT function.
Methods and Results—
Among 74 patients with endomyocardial biopsy diagnosis of FD cardiomyopathy, 13 (6 men; 7 women; mean age, 50.1±13.5 years; maximal wall thickness, 16.7±3.7 mm) had CT included in histological specimens and 6 also at electron microscopy. CT glycolipid infiltration was defined as focal, moderate, extensive, or massive, if involved ≤30%, ≤50%, >50%, or 100% of cells; identified as loosely arranged small myocytes positive to HCN4 immunostaining, supplied by a centrally placed thick-walled arteriole. CT involvement was correlated with age, sex, and α-
Gal
gene mutation. CT function was evaluated by electrophysiological study and arrhythmias at Holter registration. CT infiltration was focal/moderate in 4 women with no arrhythmias and normal electrophysiological study, extensive in 3 women with atrial or ventricular arrhythmias and short HV interval, and massive in 6 men with atrial fibrillation or ventricular arrhythmias and short HV. Short PR/AH with increased refractoriness was additionally found in 3 patients with extensive/massive CT infiltration. A male patient with the shortest HV presented infra-Hissian block during decremental atrial stimulation. There was no correlation with age, maximal wall thickness, and type of gene mutation.
Conclusions—
CT infiltration in FD cardiomyopathy is constant in men and variable in women because of skewed X-chromosome inactivation; its extensive/massive involvement causes accelerated conduction with prolonged refractoriness and electric instability.
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Affiliation(s)
- Andrea Frustaci
- From the University of Rome Sapienza (A.F., E.M., P.F, C.C.), IRCCS L. Spallanzani (E.M., F.S., C.G., R.V., C.C.), and IRCCS S. Raffaele Pisana, Rome, Italy (M.A.R.)
| | - Emanuela Morgante
- From the University of Rome Sapienza (A.F., E.M., P.F, C.C.), IRCCS L. Spallanzani (E.M., F.S., C.G., R.V., C.C.), and IRCCS S. Raffaele Pisana, Rome, Italy (M.A.R.)
| | - Matteo A. Russo
- From the University of Rome Sapienza (A.F., E.M., P.F, C.C.), IRCCS L. Spallanzani (E.M., F.S., C.G., R.V., C.C.), and IRCCS S. Raffaele Pisana, Rome, Italy (M.A.R.)
| | - Fernanda Scopelliti
- From the University of Rome Sapienza (A.F., E.M., P.F, C.C.), IRCCS L. Spallanzani (E.M., F.S., C.G., R.V., C.C.), and IRCCS S. Raffaele Pisana, Rome, Italy (M.A.R.)
| | - Claudia Grande
- From the University of Rome Sapienza (A.F., E.M., P.F, C.C.), IRCCS L. Spallanzani (E.M., F.S., C.G., R.V., C.C.), and IRCCS S. Raffaele Pisana, Rome, Italy (M.A.R.)
| | - Romina Verardo
- From the University of Rome Sapienza (A.F., E.M., P.F, C.C.), IRCCS L. Spallanzani (E.M., F.S., C.G., R.V., C.C.), and IRCCS S. Raffaele Pisana, Rome, Italy (M.A.R.)
| | - Pasquale Franciosa
- From the University of Rome Sapienza (A.F., E.M., P.F, C.C.), IRCCS L. Spallanzani (E.M., F.S., C.G., R.V., C.C.), and IRCCS S. Raffaele Pisana, Rome, Italy (M.A.R.)
| | - Cristina Chimenti
- From the University of Rome Sapienza (A.F., E.M., P.F, C.C.), IRCCS L. Spallanzani (E.M., F.S., C.G., R.V., C.C.), and IRCCS S. Raffaele Pisana, Rome, Italy (M.A.R.)
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Itier JM, Ret G, Viale S, Sweet L, Bangari D, Caron A, Le-Gall F, Bénichou B, Leonard J, Deleuze JF, Orsini C. Effective clearance of GL-3 in a human iPSC-derived cardiomyocyte model of Fabry disease. J Inherit Metab Dis 2014; 37:1013-22. [PMID: 24850378 DOI: 10.1007/s10545-014-9724-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 04/24/2014] [Accepted: 04/30/2014] [Indexed: 12/23/2022]
Abstract
Fabry disease, a rare X-linked α-galactosidase A deficiency, causes progressive lysosomal accumulation of globotriaosylceramide (GL-3) in a variety of cell types. As the disease progresses, renal failure, left ventricular hypertrophy, and strokes may occur. Enzyme replacement therapy (ERT), with recombinant α-galactosidase A, is currently available for use to reduce GL-3 deposits. However, although it improves cardiac function and decreases left ventricular mass, GL-3 clearance upon ERT has been demonstrated in cardiac capillary endothelium but not in cardiomyocytes of patients. Relevant models are needed to understand the pathogenesis of cardiac disease and explore new therapeutic approaches. We generated induced pluripotent stem cells (iPSC) from Fabry patients and differentiated them into cardiomyocytes. In these cells, GL-3 accumulates in the lysosomes over time, resulting in phenotypic changes similar to those found in cardiac tissue from Fabry patients. Using this human in vitro model, we demonstrated that substrate reduction therapy via glucosylceramide synthase inhibition was able to prevent accumulation and to clear lysosomal GL-3 in cardiomyocytes. This new in vitro model recapitulates essential features of cardiomyocytes from patients with Fabry disease and therefore provides a useful and relevant tool for further investigations of new therapy.
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Affiliation(s)
- Jean-Michel Itier
- Bio-Innovation, Global Biotherapeutics, SANOFI, 13 quai Jules Guesdes, 94400, Vitry-sur Seine, France,
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Martins E, Pinho T, Carpenter S, Leite S, Garcia R, Madureira A, Oliveira JP. Histopathological evidence of Fabry disease in a female patient with left ventricular noncompaction. Rev Port Cardiol 2014; 33:565.e1-6. [DOI: 10.1016/j.repc.2014.02.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 08/14/2014] [Indexed: 11/27/2022] Open
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Martins E, Pinho T, Carpenter S, Leite S, Garcia R, Madureira A, Oliveira JP. Histopathological evidence of Fabry disease in a female patient with left ventricular noncompaction. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2014.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Hsu TR, Sung SH, Chang FP, Yang CF, Liu HC, Lin HY, Huang CK, Gao HJ, Huang YH, Liao HC, Lee PC, Yang AH, Chiang CC, Lin CY, Yu WC, Niu DM. Endomyocardial biopsies in patients with left ventricular hypertrophy and a common Chinese later-onset Fabry mutation (IVS4 + 919G > A). Orphanet J Rare Dis 2014; 9:96. [PMID: 24980630 PMCID: PMC4100491 DOI: 10.1186/1750-1172-9-96] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 06/19/2014] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In Taiwan, DNA-based newborn screening showed a surprisingly high incidence of a cardiac Fabry mutation (IVS4 + 919G > A). The prevalence of this mutation is too high to be believed that it is a real pathogenic mutation. The purpose of this study is to identify the cardiac pathologic characteristics in patients with left ventricular hypertrophy and this mutation METHODS AND RESULTS Endomyocardial biopsies were obtained in 22 patients (Median age: 61, males: 17; females: 5) with left ventricular hypertrophy and the IVS4 + 919G > A mutation; five patients had not received enzyme replacement therapy (ERT) before biopsy, while the other 17 patients had received ERT from 8 months to 51 months. Except for three patients who had received ERT for more than 3 years, all other patients showed significant pathological change and globotriaosylceramide (Gb3) accumulation in their cardiomyocytes. In contrast to classical Fabry patients, no Gb3 accumulation was found in the capillary endothelial cells of any of our patients. Fourteen patients (63.6%) were found to have myofibrillolysis. CONCLUSIONS All of the untreated and most of the treated IVS4 + 919G > A patients showed typical pathological changes of Fabry disease in their cardiomyocytes. No endothelial accumulation of Gb3 was found, which is similar to the findings of several previous reports regarding later-onset Fabry disease. This result highly suggests that the IVS4 + 919G > A is a real pathogenic later-onset Fabry mutation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Wen-Chung Yu
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
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Costanzo L, Buccheri S, Capranzano P, Di Pino L, Curatolo G, Rodolico M, Leggio S, Blundo A, Tamburino C, Monte I. Early cardiovascular remodelling in Fabry disease. J Inherit Metab Dis 2014; 37:109-16. [PMID: 23615762 DOI: 10.1007/s10545-013-9607-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 03/24/2013] [Accepted: 03/27/2013] [Indexed: 02/06/2023]
Abstract
AIMS Fabry disease (FD) is a rare X-linked genetic disorder caused by the deficiency or absent activity of lysosomal α-galactosidase A. Cardiovascular remodelling is a hallmark of FD. The present study aimed to comprehensively evaluate the cardiac, vascular and microvascular status in a population of patients with genetic mutations for FD without left ventricular hypertrophy (LVH). METHODS AND RESULTS This study includes subjects carrying genetic mutations for FD (Fabry disease mutation-carrier, FDMC) without LVH (n = 19). A group of control subjects (n = 19) matched for age, sex, body mass index and cardiovascular risk factors were also included. All subjects underwent echocardiography, carotid ultrasound scan, endothelial flow-mediated dilatation (FMD) and nailfold capillaroscopy (NFC) assessment. When compared to the subjects in the control group, FDMC patients showed significantly lower mean values of systolic myocardial velocity (7.33 ± 1.28 vs. 10.08 ± 1.63 cm/s, p < 0.0001), longitudinal systolic strain (-18.07 ± 1.72 vs. -21.15 ± 2.22%, p < 0.0001), significantly higher E/E' mean values (7.15 ± 1.54 vs. 5.98 ± 1.27, p = 0.016) and intima-media thickness mean values (0.80 ± 0.20 vs. 0.61 ± 0.19 mm, p = 0.005), significantly lower FMD (8.3 ± 4.6 vs. 12.2 ± 5.0%, p = 0.02), more atypical capillaries and irregular NFC architecture in FDMC than control subjects (52.6 vs. 0%, p < 0.0001; 78.9 vs. 36.8%, p = 0.02 respectively). CONCLUSIONS FD progressively involves cardiac, macrovascular and microvascular systems in an early stage. These features are present even in asymptomatic mutation carriers without LVH.
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Affiliation(s)
- Luca Costanzo
- Department of "Medical and Pediatric Sciences", University of Catania, Catania, Italy
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Coats CJ, Parisi V, Ramos M, Janagarajan K, O'Mahony C, Dawnay A, Lachmann RH, Murphy E, Mehta A, Hughes D, Elliott PM. Role of serum N-terminal pro-brain natriuretic peptide measurement in diagnosis of cardiac involvement in patients with anderson-fabry disease. Am J Cardiol 2013; 111:111-7. [PMID: 23040658 DOI: 10.1016/j.amjcard.2012.08.055] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 08/20/2012] [Accepted: 08/20/2012] [Indexed: 10/27/2022]
Abstract
Enzyme replacement therapy has the potential to delay or reverse adverse cardiac remodeling in Anderson-Fabry disease (AFD); however, the current indications for enzyme replacement therapy rely on detecting relatively advanced features of the disease. We aimed to determine the relation between the serum N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration and cardiac abnormalities in patients with AFD. We hypothesized that it might help to detect early disease. NT-proBNP was measured under at rest conditions in 117 patients with AFD (age 48 ± 15 years, 46.2% men). All patients underwent clinical evaluation with electrocardiography and echocardiography. The median NT-proBNP concentration was 24 pmol/L (range <5 to 6,059). Of the 117 patients, 67 (57%) had elevated, age-corrected, NT-proBNP levels. In the 56 patients (48%) with normal echocardiographic findings, the NT-proBNP levels were greater than the age-predicted cutoffs in 10 of 25 patients with abnormal electrocardiographic findings and 3 of 31 patients with normal electrocardiographic findings (p <0.05). On multiple regression analysis, age, creatinine, left atrial volume index, E/Ea, and the presence of abnormal electrocardiographic findings were independently associated with log NT-proBNP (R(2) = 0.67, p <0.05). In conclusion, NT-proBNP concentrations were elevated in patients with AFD and early cardiac involvement, suggesting its measurement could assist in decisions regarding the timing of enzyme replacement therapy.
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Nguyen Dinh Cat A, Escoubet B, Agrapart V, Griol-Charhbili V, Schoeb T, Feng W, Jaimes E, Warnock DG, Jaisser F. Cardiomyopathy and response to enzyme replacement therapy in a male mouse model for Fabry disease. PLoS One 2012; 7:e33743. [PMID: 22574107 PMCID: PMC3344819 DOI: 10.1371/journal.pone.0033743] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 02/16/2012] [Indexed: 11/19/2022] Open
Abstract
Fabry disease is an X-linked disorder of glycosphingolipid metabolism that results in progressive accumulation of neutral glycosphingolipids, (predominately globotriaosylceramide; GL-3) in lysosomes, as well as other cellular compartments and the extracellular space. Our aim was to characterize the cardiac phenotype of male knock-out mice that are deficient in alpha-galactosidase A activity, as a model for Fabry disease and test the efficacy of Enzyme Replacement Therapy with agalsidase-beta. Male mice (3–4 months of age) were characterized with awake blood pressure and heart rate measurements, cardiac echocardiography and electrocardiography measurements under light anesthesia, histological studies and molecular studies with real-time polymerase chain reaction. The Fabry knock-out mouse has bradycardia and lower blood pressure than control wild type (CB7BL/6J) mice. In Fabry knock-out mice, the cardiomyopathy associated mild hypertrophy at echography with normal systolic LV function and mild diastolic dysfunction. Premature atrial contractions were more frequent in without conduction defect. Heart weight normalized to tibial length was increased in Fabry knock-out mice. Ascending aorta dilatation was observed. Molecular studies were consistent with early stages of cardiac remodeling. A single dose of agalsidase-beta (3 mg/kg) did not affect the LV hypertrophy, function or heart rate, but did improve the mRNA signals of early cardiac remodeling. In conclusion, the alpha-galactosidase A deficient mice at 3 to 4 months of age have cardiac and vascular alterations similar to that described in early clinical stage of Fabry disease in children and adolescents. Enzyme replacement therapy affects cardiac molecular remodeling after a single dose.
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Affiliation(s)
| | - Brigitte Escoubet
- Inserm U872 Team 1, Paris, France
- AP-HP Hôpital Bichat, Paris, France
- Centre d’Explorations Fonctionnelles-Imagerie, Bichat Federative Research Institute 02, University Denis Diderot, Paris, France
| | - Vincent Agrapart
- Inserm U872 Team 1, Paris, France
- University Pierre et Marie Curie, Paris, France
| | | | - Trenton Schoeb
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Wenguang Feng
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Edgar Jaimes
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - David G. Warnock
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Frederic Jaisser
- Inserm U872 Team 1, Paris, France
- University Pierre et Marie Curie, Paris, France
- * E-mail:
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Gruner C, Verocai F, Carasso S, Vannan MA, Jamorski M, Clarke JTR, Care M, Iwanochko RM, Rakowski H. Systolic myocardial mechanics in patients with Anderson-Fabry disease with and without left ventricular hypertrophy and in comparison to nonobstructive hypertrophic cardiomyopathy. Echocardiography 2012; 29:810-7. [PMID: 22497597 DOI: 10.1111/j.1540-8175.2012.01704.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Anderson-Fabry disease (AFD) is a lysosomal storage disease, which can involve the heart, mimicking hypertrophic cardiomyopathy (HCM). The underlying mechanism of disease in AFD is an infiltrative, diffuse process, whereas HCM is a primary heart muscle condition with patchy distribution, which may prompt differences in myocardial mechanics. The aim of this study was to assess myocardial mechanics in AFD according to the presence of left ventricular hypertrophy (LVH) compared to nonobstructive HCM (NHCM) and healthy controls. METHODS AND RESULTS We carried out a single-center, retrospective study in a small, genetically confirmed AFD cohort, which was divided into a subgroup with LVH (LVH+, n = 19), and without LVH (LVH-, n = 21). Comparison groups were healthy controls (n = 40) and NHCM patients (n = 19). Vector Velocity Imaging was applied to two-dimensional echocardiography studies for assessment of longitudinal strain (LS), circumferential strain (CS), and base-to-apex CS gradients. AFD LVH+ patients had lower global LS than AFD LVH- patients (-14 ± 4% vs -17 ± 3%, P < 0.05), but similarly lowered global CS (-24 ± 5% vs -22 ± 5%, P = ns). AFD LVH+ and NHCM had similarly lowered global LS compared to normals, but significantly lower global CS was observed in AFD LVH+ (-24 ± 5% vs -28 ± 4%, P < 0.05), whereas it was significantly increased in NHCM (-31 ± 2% vs -28 ± 4%, P < 0.05). Unlike NHCM, in both AFD subgroups, patients lost their normal base-to-apex CS gradient. CONCLUSIONS AFD patients without LVH already show abnormal systolic myocardial mechanics. Relevant differences in myocardial mechanics between AFD patients with LVH compared to NHCM reflect the different underlying mechanisms of disease.
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Affiliation(s)
- Christiane Gruner
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
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Chimenti C, Padua L, Pazzaglia C, Morgante E, Centurion C, Antuzzi D, Russo MA, Frustaci A. Cardiac and skeletal myopathy in Fabry disease: a clinicopathologic correlative study. Hum Pathol 2012; 43:1444-52. [PMID: 22406371 PMCID: PMC3423632 DOI: 10.1016/j.humpath.2011.09.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 09/20/2011] [Accepted: 09/22/2011] [Indexed: 11/26/2022]
Abstract
Skeletal muscle disturbances are commonly reported in patients with Fabry disease. Whether they derive from cardiac dysfunction or direct muscle involvement is still unclear. Clinical, noninvasive, and invasive cardiac and muscle studies, including an endomyocardial and muscle biopsy, were obtained in 12 patients (mean age, 42.1 ± 12.6 years; range, 24-58 years) with Fabry disease. In the youngest patients (group A, 4 men aged <35 years), results of cardiac and skeletal noninvasive studies were normal, except for reduced velocities in tissue Doppler imaging. Histologic examination indicated that muscle myocytes were unaffected, whereas muscle vessels showed the presence of mild glycosphingolipid accumulation in endothelial and smooth muscle cells. In the heart, cardiomyocytes and endothelial and smooth muscle cells of intramural cardiac vessels were involved by the disease. The oldest patients (group B, 6 men and 2 women aged >35 years) showed ultrasound muscle disarray and electromyography signs of myopathy, increased left ventricular mass, and normal cardiac function. Histologic examination showed that muscle myocytes contained mild glycosphingolipid accumulation compared with severe engulfment of cardiomyocytes. Moreover, similar infiltration of myocardial and muscle intramural vessels, causing lumen narrowing and fibrofatty tissue replacement, was observed. Direct muscle involvement occurs in patients with Fabry disease. It is milder and delayed compared with that in the heart. The difference in organ function and the need of residual α-galactosidase A activity are the likely causes.
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Affiliation(s)
- Cristina Chimenti
- Cardiovascular, Respiratory, Nefrologic and Geriatric Sciences Department, La Sapienza University, 00100 Rome, Italy
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Pieroni M. Echocardiographic Assessment of Fabry Cardiomyopathy: Early Diagnosis and Follow-Up. J Am Soc Echocardiogr 2011; 24:1033-6. [DOI: 10.1016/j.echo.2011.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mundigler G, Gaggl M, Heinze G, Graf S, Zehetgruber M, Lajic N, Voigtländer T, Mannhalter C, Sunder-Plassmann R, Paschke E, Fauler G, Sunder-Plassmann G. The endocardial binary appearance ('binary sign') is an unreliable marker for echocardiographic detection of Fabry disease in patients with left ventricular hypertrophy. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:744-9. [PMID: 21857019 DOI: 10.1093/ejechocard/jer112] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIMS The binary sign, a binary appearance of the left ventricular endocardial border, was suggested to be an echocardiographic hallmark in diagnosing Fabry disease, a hereditary, lysosomal storage disorder. The aim of the present study was to examine the reliability of the binary sign as a screening tool to identify patients with Fabry disease. METHODS AND RESULTS In total 309 subjects with an interventricular septum (IVS) thickness of ≥12 mm were investigated, of which 14 had a confirmed diagnosis of Fabry disease. Urinary globotriaosylceramide testing was used to rule out Fabry disease in the control group. From all patients echocardiographic images of the apical four-chamber view were analysed offline by a blinded observer. A binary sign was seen in 63 patients (20%), 4 had Fabry disease and 59 belonged to the control group. Although the proportion of binary signs in patients with Fabry disease was higher (29%) compared with the control group (20%) this difference was not statistically significant. The sensitivity and specificity were 28% (95% confidence interval (CI): 12-65%) and 80% (95% CI: 76-85%), respectively. In a logistic regression model adjusted for age, sex and presence of Fabry disease, the occurrence of a binary sign was highly dependent on the IVS thickness (odds ratio: 1.21; 95% CI: 1.1-1.35; P<0.001). CONCLUSION The endocardial binary appearance is associated with the degree of septal hypertrophy but cannot adequately distinguish between patients with Fabry disease and patients with other causes of left ventricular hypertrophy.
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Affiliation(s)
- Gerald Mundigler
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
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Myocardial Alterations in the Murine Model of Fabry Disease Can Be Reversed by Enzyme Replacement Therapy. Can J Cardiol 2011; 27:339-45. [DOI: 10.1016/j.cjca.2010.12.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 09/28/2010] [Indexed: 11/21/2022] Open
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Pinto JR, Yang SW, Hitz MP, Parvatiyar MS, Jones MA, Liang J, Kokta V, Talajic M, Tremblay N, Jaeggi M, Andelfinger G, Potter JD. Fetal cardiac troponin isoforms rescue the increased Ca2+ sensitivity produced by a novel double deletion in cardiac troponin T linked to restrictive cardiomyopathy: a clinical, genetic, and functional approach. J Biol Chem 2011; 286:20901-12. [PMID: 21502316 DOI: 10.1074/jbc.m111.234336] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A novel double deletion in cardiac troponin T (cTnT) of two highly conserved amino acids (Asn-100 and Glu-101) was found in a restrictive cardiomyopathic (RCM) pediatric patient. Clinical evaluation revealed the presence of left atrial enlargement and marked left ventricle diastolic dysfunction. The explanted heart examined by electron microscopy revealed myofibrillar disarray and mild fibrosis. Pedigree analysis established that this mutation arose de novo. The patient tested negative for six other sarcomeric genes. The single and double recombinant cTnT mutants were generated, and their functional consequences were analyzed in porcine skinned cardiac muscle. In the adult Tn environment (cTnT3 + cardiac troponin I), the single cTnT3-ΔN100 and cTnT3-ΔE101 mutations had opposing effects on the Ca(2+) sensitivity of force development compared with WT, whereas the double deletion cTnT3-ΔN100/ΔE101 increased the Ca(2+) sensitivity + 0.19 pCa units. In addition, cTnT3-ΔN100/ΔE101 decreased the cooperativity of force development, suggesting alterations in intrafilament protein-protein interactions. In the fetal Tn environment, (cTnT1 + slow skeletal troponin I), the single (cTnT1-ΔN110) and double (cTnT1-ΔN110/ΔE111) deletions did not change the Ca(2+) sensitivity compared with control. To recreate the patient's heterozygous genotype, we performed a reconstituted ATPase activity assay. Thin filaments containing 50:50 cTnT3-ΔN100/ΔE101:cTnT3-WT also increased the myofilament Ca(2+) sensitivity compared with WT. Co-sedimentation of thin filament proteins indicated that no significant changes occurred in the binding of Tn containing the RCM cTnT mutation to actin-Tm. This report reveals the protective role of Tn fetal isoforms as they rescue the increased Ca(2+) sensitivity produced by a cTnT-RCM mutation and may account for the lack of lethality during gestation.
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Affiliation(s)
- Jose Renato Pinto
- University of Miami Miller School of Medicine, Miami, Florida 33136, USA
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Diastolic myofilament dysfunction in the failing human heart. Pflugers Arch 2011; 462:155-63. [PMID: 21487693 PMCID: PMC3114087 DOI: 10.1007/s00424-011-0960-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 03/23/2011] [Accepted: 03/24/2011] [Indexed: 01/06/2023]
Abstract
In recent years, it has become evident that heart failure is not solely due to reduced contractile performance of the heart muscle as impaired relaxation is evident in almost all heart failure patients. In more than half of all heart failure patients, diastolic dysfunction is the major cardiac deficit. These heart failure patients have normal (or preserved) left ventricular ejection fraction, but impaired diastolic function evident from increased left ventricular end-diastolic pressure. Perturbations at the cellular level which cause impaired relaxation of the heart muscle involve changes in Ca(2+)-handling proteins, extracellular matrix components, and myofilament properties. The present review discusses the deficits in myofilament function observed in human heart failure and the most likely underlying causal protein changes. Moreover, the consequences of impaired myofilament function for in vivo diastolic dysfunction are discussed taking into account the reported changes in Ca(2+) handling.
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The heart in Fabry's disease. Cardiovasc Pathol 2011; 20:8-14. [DOI: 10.1016/j.carpath.2009.10.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 09/17/2009] [Accepted: 10/09/2009] [Indexed: 11/18/2022] Open
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Mutation patterns in human α-galactosidase A. Mol Divers 2010; 14:147-54. [PMID: 19468850 PMCID: PMC7088632 DOI: 10.1007/s11030-009-9158-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2009] [Accepted: 04/29/2009] [Indexed: 12/02/2022]
Abstract
A way to study the mutation pattern is to convert a 20-letter protein sequence into a scalar protein sequence, because the 20-letter protein sequence is neither vector nor scalar while a promising way to study patterns is in numerical domain. In this study, we use the amino-acid pair predictability to convert α-galactosidase A with its 137 mutations into scalar sequences, and analyse which amino-acid pairs are more sensitive to mutation. Our results show that the unpredictable amino-acid pairs are more sensitive to mutation, and the mutation trend is to narrow the difference between predicted and actual frequency of amino-acid pairs.
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Hoffmann B. Fabry disease: recent advances in pathology, diagnosis, treatment and monitoring. Orphanet J Rare Dis 2009; 4:21. [PMID: 19818152 PMCID: PMC2768700 DOI: 10.1186/1750-1172-4-21] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Accepted: 10/11/2009] [Indexed: 02/05/2023] Open
Abstract
Background In Fabry disease (α-galactosidase A deficiency) accumulation of Globotriaosylceramide (Gb3) leads to progressive organ failure and premature death. The introduction of enzyme replacement therapy (ERT) was the beginning of a new era in this disorder, and has prompted a broad range of research activities. This review aims to summarize recent developments and progress with high impact for Fabry disease. Methods A Pubmed analysis was performed using the search terms "Fabry disease", "Anderson-Fabry disease", "alpha-galactosidase A" and "Gb3". Of the given publications by 31st January 2009 only original articles recently published in peer reviewed journals were included for this review. Case reports were included only when they comprised a new aspect. In addition we included relevant conference abstracts when the results had not already been published as original articles. Results Apart from Gb3-accumulation cellular and organ specific damages may be related also to inflammatory and immunological consequences. It will be interesting whether this may lead to new therapeutic strategies in the treatment of Fabry disease. Since newborn screening is still difficult in Fabry disease, detection of patients in populations at risk is of great importance. Undiagnosed patients with Fabry disease may still be found in cohorts of subjects with renal diseases, cardiomyopathy and TIA or stroke. Efforts should be undertaken to identify these individuals and initialise ERT in order to hault disease progression. It has also been demonstrated that Gb3-accumulation leads to pre-clinical damages and it is believed that early treatment may be the only possibility so far to prevent irreversible organ damage.
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Affiliation(s)
- Björn Hoffmann
- Department for General Pediatrics, University Children's Hospital, Heinrich-Heine-University Düsseldorf, Germany.
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Life expectancy and cause of death in males and females with Fabry disease: Findings from the Fabry Registry. Genet Med 2009; 11:790-6. [DOI: 10.1097/gim.0b013e3181bb05bb] [Citation(s) in RCA: 210] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Hoffmann B, Mayatepek E. Fabry disease-often seen, rarely diagnosed. DEUTSCHES ARZTEBLATT INTERNATIONAL 2009; 106:440-7. [PMID: 19623315 DOI: 10.3238/arztebl.2009.0440] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2008] [Accepted: 12/18/2008] [Indexed: 12/27/2022]
Abstract
BACKGROUND Data obtained from screened newborns and from persons at known risk for Fabry disease suggest that this condition is much more common in Germany than previously assumed. Its clinical manifestations are very diverse, and its differential diagnosis is correspondingly broad. Thus, there is often a delay before the diagnosis of Fabry disease is established. METHODS Selective literature search with special attention to studies of large groups of patients with respect to clinical manifestations, diagnostic evaluation, and treatment. RESULTS The number of patients carrying the diagnosis of Fabry disease in Germany lies far below what would be expected from published prevalence figures from other countries. Angiokeratoma, acroparesthesia, hypertrophic cardiomyopathy, impaired sweating and corneal opacification (cornea verticillata) are typical manifestations of Fabry disease; many patients also have other, nonspecific complaints, such as gastrointestinal disturbances. It has been clearly shown that women can manifest the entire range of clinical manifestations. Studies involving large groups of patients have improved our understanding of hearing impairment and tinnitus in Fabry disease. Therapeutic trials are currently in progress to determine whether enzyme substitution can delay the occurrence of life-threatening sequelae such as progressive renal failure and cerebrovascular events. CONCLUSIONS Fabry disease is still underdiagnosed. The average delay from the onset of symptoms to diagnosis is more than a decade. Treatment with human alpha-galactosidase A produced with genetic technology can improve most of the disease's manifestations.
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Affiliation(s)
- Björn Hoffmann
- Klinik für Allgemeine Pädiatrie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Germany.
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Rohard I, Schaefer E, Kampmann C, Beck M, Gal A. Association between polymorphisms of endothelial nitric oxide synthase gene (NOS3) and left posterior wall thickness (LPWT) of the heart in Fabry disease. J Inherit Metab Dis 2008; 31 Suppl 2:S349-56. [PMID: 18941922 DOI: 10.1007/s10545-008-0920-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Revised: 08/09/2008] [Accepted: 08/19/2008] [Indexed: 10/21/2022]
Abstract
Fabry disease is an X-chromosomal storage disorder due to loss-of-function mutations of the GLA gene encoding the lysosomal enzyme α-galactosidase A. Accumulating glycosphingolipid deposits disturb the function of various cells, in particular that of myocytes, arterial smooth-muscle cells, and vascular endothelium. Hypertrophic cardiomyopathy, for example measured by left posterior wall thickness (LPWT) of the heart, represents a major component of Fabry disease morbidity in adult patients. Endothelium-derived nitric oxide (eNO), produced by eNO synthase (eNOS), is a key regulator of vessel wall function and cardiovascular homeostasis. We analysed the effect of the polymorphisms c.894G > T (p.Glu298Asp) in exon 7 and the 27 bp tandem repeat (VNTR; allele a: 4 and allele b: 5 repeats) in intron 4 of the NOS3 gene, encoding eNOS, on LPWT of 102 patients with Fabry disease. For the association analysis, the distance of each patient's LPWT value from the cohort-specific, age-dependent regression line point (expected values) was used. In the cohort of 46 male patients, LPWT mean value of the group with GG genotype at position c.894 was smaller by 1 mm than that of (GT + TT) (p = 0.058). LPWT of patients with bb was thicker by 1.4 mm than that of (ab + aa) (p = 0.022). In patients with haplotype Ga, a thinner LPWT was seen than in those with Tb (p = 0.006). While no correlation was found between the GLA genotype and LPWT, the difference of 2.44 mm between the relative LPWT mean values of the two extreme NOS3 groups corresponds to the absolute LPWT increase that an average male patient with Fabry disease experiences during about 12 years. These are the first data showing a significant association of non-GLA-derived sequence variants with the cardiac phenotype in Fabry disease that may in part explain the great phenotypic variability of the disease.
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Affiliation(s)
- I Rohard
- Institute of Human Genetics, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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