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Leung SPY, Dougherty S, Zhang XY, Kam KKH, Chi WK, Chan JYS, Fung E, Wong JKT, Choi PCL, Chan DKH, Sheng B, Lee APW. The Asian Fabry Cardiomyopathy High-Risk Screening Study 2 (ASIAN-FAME-2): Prevalence of Fabry Disease in Patients with Left Ventricular Hypertrophy. J Clin Med 2024; 13:3896. [PMID: 38999464 PMCID: PMC11242528 DOI: 10.3390/jcm13133896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/25/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Fabry disease (FD) is a rare X-linked lysosomal storage disorder that commonly manifests cardiovascular complications. We aimed to assess the prevalence of FD in a Chinese population with left ventricular hypertrophy (LVH) whilst implementing a gender-specific screening approach. Methods: Patients with LVH, defined as a maximum thickness of the left ventricular septal/posterior wall ≥ 13 mm, were considered eligible. All patients with hypertrophic cardiomyopathy (HCM) were excluded. Plasma α-galactosidase (α-GLA) enzyme activity was assessed using a dried blood spot test. Males with low enzyme activity underwent genetic testing to confirm a diagnosis of FD whereas females were screened for both α-GLA and globotriaosylsphingosine concentration and underwent genetic analysis of the GLA gene only if testing positive for ≥1 parameter. Results: 426 unrelated patients (age = 64.6 ± 13.0 years; female: male = 113:313) were evaluated. FD was diagnosed in 3 unrelated patients (age = 69.0 ± 3.5 years, female: male = 1:2) and 1 related female subject (age = 43 years). Genetic analyses confirmed the late-onset cardiac variant GLA c.640-801G>A (n = 3) and the missense variant c.869T>C associated with classic FD (n = 1). Cardiac complications were the only significant findings associated with the late-onset c.640-801G>A mutation, manifesting as mild or severe concentric LVH. In contrast, the classic c.869T>C mutation FD exhibited multisystemic manifestations in addition to severe concentric LVH. Conclusions: The prevalence of FD is lower in Chinese patients with LVH when HCM is excluded. The pathological variant c.640-801G>A remains the most common cause of late-onset FD, while the detection of FD in females can be improved by utilizing a gender-specific screening method.
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Affiliation(s)
- Sophia Po-Yee Leung
- Laboratory of Cardiac Imaging and 3D Printing, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China
| | - Scott Dougherty
- Department of Cardiology, Tseung Kwan O Hospital, Hong Kong, China
| | - Xiao-Yu Zhang
- Laboratory of Cardiac Imaging and 3D Printing, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China
| | - Kevin K H Kam
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Wai-Kin Chi
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Joseph Y S Chan
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Erik Fung
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Jeffrey K T Wong
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Paul C L Choi
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | - David K H Chan
- Elderly Health Service, 11/F, ChinaChem Exchange Square, 1 Hoi Wan St, Quarry Bay, Hong Kong, China
| | - Bun Sheng
- Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Kwai Chung, Hong Kong, China
| | - Alex Pui-Wai Lee
- Laboratory of Cardiac Imaging and 3D Printing, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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Savostyanov K, Pushkov A, Zhanin I, Mazanova N, Trufanov S, Pakhomov A, Alexeeva A, Sladkov D, Asanov A, Fisenko A. The prevalence of Fabry disease among 1009 unrelated patients with hypertrophic cardiomyopathy: a Russian nationwide screening program using NGS technology. Orphanet J Rare Dis 2022; 17:199. [PMID: 35578305 PMCID: PMC9109305 DOI: 10.1186/s13023-022-02319-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/09/2022] [Indexed: 12/03/2022] Open
Abstract
Background There is a vast number of screening studies described in the literature from the beginning of the twenty-first century to the present day. Many of these studies are related to the estimation of Fabry disease (FD) morbidity among patients from high-risk groups, including adult patients with hypertrophic cardiomyopathy (HCM) and left ventricular hypertrophy (LVH). These studies show diverse detection frequencies (0–12%) depending on the methodology. Our study is the only example of large-scale selective FD screening based on the implementation of next-generation sequencing technology (NGS) as a first-level test to estimate FD morbidity in the Russian population over 18 years of age burdened with HCM. Methods The study included 1009 patients (578 males and 431 females), with a median age of 50 years, who were diagnosed with HCM according to current clinical guidelines. In the first stage of screening, all patients underwent molecular genetic testing (NGS method) of target regions. These regions included the coding sequences of 17 genes and mutations that can lead to the development of HCM. Lysosomal globotriaosylsphingosine (lyso-Gb3) concentrations and α-galactosidase A (α-gal A) enzyme activity were measured in the second stage of screening to reveal pathogenic or likely pathogenic variants in the GLA gene. Results We revealed 8 (0.8%) patients (3 (37.5%) males and 5 (62.5%) females) with an average age of 59 ± 13.3 years who had pathogenic, likely pathogenic variants and variants of uncertain significance (VUS) in the GLA gene (NM_000169.2) as a result of selective screening of 1009 Russian patients with HCM. FD was confirmed via biochemical tests in a male with the pathogenic variant c.902G > A, p.R301Q as well as in two females with likely pathogenic variants c.897C > A, p.D299E and c.1287_1288dup, p.*430Fext*?. These tests showed reduced enzymatic activity and increased substrate concentration. However, a female with the pathogenic variant c.416A > G, p.N139S and with normal enzymatic activity only had increased substrate concentrations. The revealed nucleotide variants and high values of biochemical indicators (lyso-Gb3) in these 4 patients allowed us to estimate the FD diagnosis among 1009 Russian patients with HCM. Mild extracardiac manifestations were observed in these four patients; however, both biochemical values within the reference range in females with the c.971T > G, p.L324W (VUS) variant. α-gal A activity and lyso-Gb3 concentrations were also within the normal range in two males with hemizygous variants, c.546T > C, p.D182D and c.640-794_640-791del (we regarded them as VUS), and in one female with the c.427G > A, p.A143T variant (with conflicting interpretations of pathogenicity). Conclusion The prevalence rate of FD among 1,009 adult Russian patients with HCM was 0.4%. We recommend FD screening among adult patients of both sexes with HCM and an undefined genetic cause via NGS method with subsequent analysis of α-gal A activity and lyso-Gb3 concentration in patients with pathogenic, likely pathogenic variants, and VUS. This strategy identifies patients with an atypical form of FD that is characterized by high residual activity of α-gal A, low concentrations of lyso-Gb3, and minor extracardiac manifestations.
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Citro R, Prota C, Ferraioli D, Iuliano G, Bellino M, Radano I, Silverio A, Migliarino S, Polito MV, Ruggiero A, Napoletano R, Bellizzi V, Ciccarelli M, Galasso G, Vecchione C. Importance of Echocardiography and Clinical “Red Flags” in Guiding Genetic Screening for Fabry Disease. Front Cardiovasc Med 2022; 9:838200. [PMID: 35548424 PMCID: PMC9081601 DOI: 10.3389/fcvm.2022.838200] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/24/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Aim of this study was to evaluate, in a metropolitan area not already explored, the prevalence of Anderson–Fabry disease, by genetic screening, in patients with echocardiographic evidence of left ventricular hypertrophy (LVH) of unknown origin and “clinical red flags”. Methods From August 2016 to October 2017, all consecutive patients referring to our echo-lab for daily hospital practices with echocardiographic evidence of LVH of unknown origin in association with history of at least one of the classical signs and symptoms related to Fabry disease (FD) (neuropathic pain, anhidrosis/hypohidrosis, angiokeratomas, gastrointestinal problems, chronic kidney disease, or cerebrovascular complications) were considered eligible for the FD genetic screening program. Through dried blood spot testing, α-Galactosidase A (α-Gal A) activity and analysis of the GLA gene were performed. Results Among 3,360 patients who underwent transthoracic echocardiography in our echo-lab during the study period, 30 patients (0.89%; 19 men, mean age 58 ± 18.2 years) were selected. FD was diagnosed in 3 (10%) unrelated patients. Three different GLA gene mutations were detected, one of them [mutation c.388A > G (p.Lys130Glu) in exon 3] never described before. Moreover, probands' familiar genetic screening allowed the identification of 5 other subjects affected by FD. Conclusion In a metropolitan area not previously investigated, among patients with LVH of unknown origin associated with other “red flags,” undergoing genetic screening, the prevalence of FD was very high (10%). Our results highlight the importance of an echocardiographic- and clinical-oriented genetic screening for FD in patients with uncommon cause of LVH.
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Affiliation(s)
- Rodolfo Citro
- Heart Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
- Vascular Physiopathology Unit, Department of Angio-Cardio-Neurology, IRCCS Neuromed, Pozzilli, Italy
- *Correspondence: Rodolfo Citro
| | - Costantina Prota
- Heart Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Donatella Ferraioli
- Heart Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Giuseppe Iuliano
- Heart Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Michele Bellino
- Heart Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Ilaria Radano
- Heart Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Angelo Silverio
- Heart Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Serena Migliarino
- Heart Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Maria Vincenza Polito
- Heart Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Artemisia Ruggiero
- Heart Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Rosa Napoletano
- Heart Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Vincenzo Bellizzi
- Heart Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Michele Ciccarelli
- Heart Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Gennaro Galasso
- Heart Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Carmine Vecchione
- Heart Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
- Vascular Physiopathology Unit, Department of Angio-Cardio-Neurology, IRCCS Neuromed, Pozzilli, Italy
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Sawada T, Kido J, Sugawara K, Nakamura K. High-Risk Screening for Fabry Disease: A Nationwide Study in Japan and Literature Review. Diagnostics (Basel) 2021; 11:diagnostics11101779. [PMID: 34679477 PMCID: PMC8534369 DOI: 10.3390/diagnostics11101779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/26/2022] Open
Abstract
Fabry disease (FD) is an X-linked inherited disorder caused by mutations in the GLA gene, which encodes the lysosomal enzyme α-galactosidase A (α-Gal A). FD detection in patients at an early stage is essential to achieve sufficient treatment effects, and high-risk screening may be effective. Here, we performed high-risk screening for FD in Japan and showed that peripheral neurological manifestations are important in young patients with FD. Moreover, we reviewed the literature on high-risk screening in patients with renal, cardiac, and central neurological manifestations. Based on the results of this study and review of research abroad, we believe that FD can be detected more effectively by targeting individuals based on age. In recent years, the methods for high-risk screening have been ameliorated, and high-risk screening studies using GLA next-generation sequencing have been conducted. Considering the cost-effectiveness of screening, GLA sequencing should be performed in individuals with reduced α-Gal A activity and females with certain FD manifestations and/or a family history of FD. The findings suggest that family analysis would likely detect FD patients, although GLA sequencing of asymptomatic family members requires adequate genetic counseling.
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Affiliation(s)
- Takaaki Sawada
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City 860-8556, Japan; (T.S.); (K.S.); (K.N.)
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City 860-8556, Japan
| | - Jun Kido
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City 860-8556, Japan; (T.S.); (K.S.); (K.N.)
- Correspondence: ; Tel.: +81-096-373-5191; Fax: +81-096-373-5335
| | - Keishin Sugawara
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City 860-8556, Japan; (T.S.); (K.S.); (K.N.)
| | - Kimitoshi Nakamura
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City 860-8556, Japan; (T.S.); (K.S.); (K.N.)
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Linhart A, Germain DP, Olivotto I, Akhtar MM, Anastasakis A, Hughes D, Namdar M, Pieroni M, Hagège A, Cecchi F, Gimeno JR, Limongelli G, Elliott P. An expert consensus document on the management of cardiovascular manifestations of Fabry disease. Eur J Heart Fail 2020; 22:1076-1096. [PMID: 32640076 DOI: 10.1002/ejhf.1960] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/04/2020] [Accepted: 07/04/2020] [Indexed: 12/18/2022] Open
Abstract
Fabry disease (FD) is an X-linked lysosomal storage disorder caused by pathogenic variants in the α-galactosidase A (GLA) gene that leads to reduced or undetectable α-galactosidase A enzyme activity and progressive accumulation of globotriaosylceramide and its deacylated form globotriaosylsphingosine in cells throughout the body. FD can be multisystemic with neurological, renal, cutaneous and cardiac involvement or be limited to the heart. Cardiac involvement is characterized by progressive cardiac hypertrophy, fibrosis, arrhythmias, heart failure and sudden cardiac death. The cardiac management of FD requires specific measures including enzyme replacement therapy or small pharmacological chaperones in patients carrying amenable pathogenic GLA gene variants and more general management of cardiac symptoms and complications. In this paper, we summarize current knowledge of FD-related heart disease and expert consensus recommendations for its management.
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Affiliation(s)
- Aleš Linhart
- Second Department of Internal Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Dominique P Germain
- Division of Medical Genetics, University of Versailles and AP-HP Paris-Saclay, Paris, France
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Mohammed M Akhtar
- Institute of Cardiovascular Science, University College London and Barts Heart Centre, London, UK
| | - Aris Anastasakis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Center, Kallithea, Greece
| | - Derralynn Hughes
- Royal Free London NHS Foundation Trust and University College London, London, UK
| | - Mehdi Namdar
- Department of Internal Medicine Specialties, Cardiology, Electrophysiology, University Hospital of Geneva, Geneva, Switzerland
| | - Maurizio Pieroni
- Cardiomyopathy Clinic, Cardiovascular Department, San Donato Hospital, Arezzo, Italy
| | - Albert Hagège
- Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,INSERM CMR970, Paris Cardiovascular Research Center PARCC, Paris, France
| | - Franco Cecchi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy.,IRCCS, Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Juan R Gimeno
- Hospital C. Universitario Virgen Arrixaca, Murcia, Spain
| | - Giuseppe Limongelli
- Dipartimento di Scienze Mediche Traslazionali, Università della Campania "Luigi Vanvitelli", AORN Colli, Ospedale Monaldi, Naples, Italy
| | - Perry Elliott
- Institute of Cardiovascular Science, University College London and Barts Heart Centre, London, UK
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Azevedo O, Marques N, Reis L, Cruz I, Craveiro N, Antunes H, Lourenço C, Gomes R, Guerreiro RA, Faria R, Sá F, Lima R, Gaspar P, Faria R, Miltenberger-Miltenyi G, Sousa N, Cunha D. Predictors of Fabry disease in patients with hypertrophic cardiomyopathy: How to guide the diagnostic strategy? Am Heart J 2020; 226:114-126. [PMID: 32531501 DOI: 10.1016/j.ahj.2020.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 04/12/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Fabry disease (FD) is a treatable cause of hypertrophic cardiomyopathy (HCM). We aimed to determine the independent predictors of FD and to define a clinically useful strategy to discriminate FD among HCM. METHODS Multicenter study including 780 patients with the ESC definition of HCM. FD screening was performed by enzymatic assay in males and genetic testing in females. Multivariate regression analysis identified independent predictors of FD in HCM. A discriminant function analysis defined a score based on the weighted combination of these predictors. RESULTS FD was found in 37 of 780 patients with HCM (4.7%): 31 with p.F113L mutation due to a founder effect; and 6 with other variants (p.C94S; p.M96V; p.G183V; p.E203X; p.M290I; p.R356Q/p.G360R). FD prevalence in HCM adjusted for the founder effect was 0.9%. Symmetric HCM (OR 3.464, CI95% 1.151-10.430), basal inferolateral late gadolinium enhancement (LGE) (OR 10.677, CI95% 3.633-31.380), bifascicular block (OR 10.909, CI95% 2.377-50.059) and ST-segment depression (OR 4.401, CI95% 1.431-13.533) were independent predictors of FD in HCM. The score ID FABRY-HCM [-0.729 + (2.781xBifascicular block) + (0.590xST depression) + (0.831xSymmetric HCM) + (2.130xbasal inferolateral LGE)] had a negative predictive value of 95.8% for FD, with a cut-off of 1.0, meaning that, in the absence of both bifascicular block and basal inferolateral LGE, FD is a less probable cause of HCM, being more appropriate to perform HCM gene panel than targeted FD screening. CONCLUSION FD prevalence in HCM was 0.9%. Bifascicular block and basal inferolateral LGE were the most powerful predictors of FD in HCM. In their absence, HCM gene panel is the most appropriate step in etiological study of HCM.
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Sakuraba H, Tsukimura T, Togawa T, Tanaka T, Ohtsuka T, Sato A, Shiga T, Saito S, Ohno K. Fabry disease in a Japanese population-molecular and biochemical characteristics. Mol Genet Metab Rep 2018; 17:73-79. [PMID: 30386727 PMCID: PMC6205336 DOI: 10.1016/j.ymgmr.2018.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/12/2018] [Accepted: 10/12/2018] [Indexed: 12/27/2022] Open
Abstract
We had experienced 117 Japanese Fabry patients (72 males and 45 females) from 1977 to 2006, and then we generated an improved Fabry analysis system in 2007 and have found 196 ones (95 males and 101 females) since then. In this study, we summarized the data of the patients and tried to elucidate the molecular and biochemical characteristics of Japanese Fabry patients. Gene analysis revealed various GLA mutations, including missense mutations (56.5%, 48 types); nonsense mutations (15.9%, 13 types); deletions (12.6%, 13 types); splicing defects (10.1%, 6 types); insertions (1.0%, 2 types), and insertions/deletions (0.5%, 1 type), in the patients that were tested. Amino acid substitutions resulting from the missense mutations found in the classic form patients tended to be localized in the core of the GLA protein, and those in the later-onset ones in the peripheral region. The most commonly identified pathogenic mutations are c.888G > A (p.M296I), c.936 + 919G > A, c.679C > T (p.R227X), c.335G > A (p.R112H), c.334C > T (p.R112C), and c.902G > A (p.R301Q). Among them, c.888G > A (p.M296I) is unique to Japanese Fabry patients. On the other hand, c.936 + 919G > A is a variant that has been frequently detected in Taiwan Chinese Fabry patients, and c.335G > A (p.R112H) in various countries. These are found in later-onset patients, and c.679C > T (p.R227X) and c.334C > T (p.R112C) classic ones. c.902G > A (p.R301Q) is found in both classic and later-onset form patients. A possible functional polymorphism, c.196G > C (p.E66Q), was identified in 0.4% of the subjects who underwent high-risk screening. The biochemical findings including leukocyte α-galactosidase A activity, plasma globotriaosylsphingosine level and urinary globotriaosylceramide in the individual phenotypic groups well reflected the phenotypic differences in this disease. The results will be useful for understanding the basis of Fabry disease in Japan. The characteristics of Japanese Fabry patients were elucidated. p.M296I unique to Japanese Fabry patients was commonly identified. The biochemical findings well reflected the phenotypic differences.
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Affiliation(s)
- Hitoshi Sakuraba
- Department of Clinical Genetics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Takahiro Tsukimura
- Department of Functional Bioanalysis, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Tadayasu Togawa
- Department of Functional Bioanalysis, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Toshie Tanaka
- Department of Clinical Genetics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Tomoko Ohtsuka
- Department of Clinical Genetics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Atsuko Sato
- Department of Clinical Genetics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Tomoko Shiga
- Department of Clinical Genetics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Seiji Saito
- Department of Medical Management and Informatics, Hokkaido Information University, 59-2 Nishi-nopporo, Ebetsu, Hokkaido 069-8585, Japan
| | - Kazuki Ohno
- Catalyst Inc., 1-5-6 Kudan-minami, Chiyoda-ku, Tokyo 102-0074, Japan
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Low frequency of Fabry disease in patients with common heart disease. Genet Med 2017; 20:754-759. [PMID: 29227985 DOI: 10.1038/gim.2017.175] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 09/05/2017] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To test the hypothesis that undiagnosed patients with Fabry disease exist among patients affected by common heart disease. METHODS Globotriaosylceramide in random whole urine using tandem mass spectroscopy, α-galactosidase A activity in dried blood spots, and next-generation sequencing of pooled or individual genomic DNA samples supplemented by Sanger sequencing. RESULTS We tested 2,256 consecutive patients: 852 women (median age 65 years (19-95)) and 1,404 men (median age 65 years (21-92)). The primary diagnoses were coronary artery disease (n = 994), arrhythmia (n = 607), cardiomyopathy (n = 138), and valvular disease (n = 568). Urinary globotriaosylceramide was elevated in 15% of patients and 15 males had low α-galactosidase A activity. GLA variants found included R118C (n = 2), D83N, and D313Y (n = 7); IVS6-22 C>T, IVS4-16 A>G, IVS2+990C>A, 5'UTR-10 C>T (n = 4), IVS1-581 C>T, IVS1-1238 G>A, 5'UTR-30 G>A, IVS2+590C>T, IVS0-12 G>A, IVS4+68A>G, IVS0-10 C>T, IVS2-81-77delCAGCC, IVS2-77delC. Although the pathogenicity of several of these missense mutations and complex intronic haplotypes has been controversial, none of the patients screened in this study were diagnosed definitively with Fabry disease. CONCLUSION This population of patients with common heart disease did not contain a substantial number of patients with undiagnosed Fabry disease. GLA gene sequencing is superior to urinary globotriaosylceramide or α-galactosidase A activity in the screening for Fabry disease.
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