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Sansone L, Barreca F, Belli M, Aventaggiato M, Russo A, Perrone GA, Russo MA, Tafani M, Frustaci A. Infertility in Fabry's Disease: role of hypoxia and inflammation in determining testicular damage. Front Endocrinol (Lausanne) 2024; 15:1340188. [PMID: 38455658 PMCID: PMC10917934 DOI: 10.3389/fendo.2024.1340188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/12/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Fabry's disease (FD) is a genetic X-linked systemic and progressive rare disease characterized by the accumulation of globotriaosylceramide (GB3) into the lysosomes of many tissues. FD is due to loss-of-function mutations of α-galactosidase, a key-enzyme for lysosomal catabolism of glycosphingolipids, which accumulate as glycolipid bodies (GB). In homozygous males the progressive deposition of GB3 into the cells leads to clinical symptoms in CNS, skin, kidney, etc. In testis GB accumulation causes infertility and alterations of spermatogenesis. However, the precise damaging mechanism is still unknown. Our hypothesis is that GB accumulation reduces blood vessel lumen and increases the distance of vessels from both stromal cells and seminiferous parenchyma; this, in turn, impairs oxygen and nutrients diffusion leading to subcellular degradation of seminiferous epithelium and sterility. Methods To test this hypothesis, we have studied a 42-year-old patient presenting a severe FD and infertility, with reduced number of spermatozoa, but preserved sexual activity. Testicular biopsies were analyzed by optical (OM) and transmission electron microscopy (TEM). Activation and cellular localization of HIF-1α and NFκB was analyzed by immunofluorescence (IF) and RT-PCR on homogeneous tissue fractions after laser capture microdissection (LCMD). Results OM and TEM showed that GB were abundant in vessel wall cells and in interstitial cells. By contrast, GB were absent in seminiferous epithelium, Sertoli's and Leydig's cells. However, seminiferous tubular epithelium and Sertoli's cells showed reduced diameter, thickening of basement membrane and tunica propria, and swollen or degenerated spermatogonia. IF showed an accumulation of HIF-1α in stromal cells but not in seminiferous tubules. On the contrary, NFκB fluorescence was evident in tubules, but very low in interstitial cells. Finally, RT-PCR analysis on LCMD fractions showed the expression of pro-inflammatory genes connected to the HIF-1α/NFκB inflammatory-like pathway. Conclusion Our study demonstrates that infertility in FD may be caused by reduced oxygen and nutrients due to GB accumulation in blood vessels cells. Reduced oxygen and nutrients alter HIF-1α/NFκB expression and localization while activating HIF-1α/NFκB driven-inflammation-like response damaging seminiferous tubular epithelium and Sertoli's cells.
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Affiliation(s)
- Luigi Sansone
- Laboratory of Cellular and Molecular Pathology, IRCCS San Raffaele, Rome, Italy
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
| | - Federica Barreca
- Laboratory of Cellular and Molecular Pathology, Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Manuel Belli
- Laboratory of Cellular and Molecular Pathology, IRCCS San Raffaele, Rome, Italy
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
| | - Michele Aventaggiato
- Laboratory of Cellular and Molecular Pathology, Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Andrea Russo
- UOC of Pathologic Anatomy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Matteo A. Russo
- Laboratory of Cellular and Molecular Pathology, IRCCS San Raffaele, Rome, Italy
| | - Marco Tafani
- Laboratory of Cellular and Molecular Pathology, Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Andrea Frustaci
- Laboratory of Cellular and Molecular Pathology, IRCCS San Raffaele, Rome, Italy
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Emecen Sanli M, Kilic A, Inci A, Okur I, Ezgu F, Tumer L. Endocrinological, immunological and metabolic features of patients with Fabry disease under therapy. J Pediatr Endocrinol Metab 2023; 0:jpem-2023-0105. [PMID: 37257483 DOI: 10.1515/jpem-2023-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/20/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Fabry disease is an X-linked lysosomal disorder caused by decreased or absent alpha galactosidase enzyme. The enzyme deficiency leads to progressive accumulation of globotriaosylceramide (Gb-3) and its deacetylated form lyso-Gb3 in various tissue lysosomes that results in primarily lysosomal deterioration and subsequently mitochondrial, endothelial, and immunologic dysfunctions. METHODS The endocrinological, metabolic, immunological and HLA status of 12 patients were evaluated. RESULTS A total of 11 patients (91.6 %) had immunologic and/or endocrinologic abnormalities. fT4, anti-TPO, and anti-TG levels were increased in 1, 2, and 2 patients, respectively. Three patients had elevated proinflammatory cytokines. ANA profile, p-ANCA and c-ANCA were positive in 1, 1, and 2 patients, respectively. Tissue transglutaminase antibody was negative in all patients however P5 was diagnosed with Celiac disease at the age of 12 and on gluten free diet. All patients had distinct types of HLA apart from 2 patients with anti-TG and anti-TPO positive and there was no relationship between the HLA types and the autoimmunity biomarkers. CONCLUSIONS FD may have impact on endocrinologic and immunologic abnormalities even in the patients under ERT, therefore prevalence of these abnormalities may be higher in ERT naïve patients. However, apparently, they are less likely to cause clinical symptoms. Certain HLA alleles may contribute to the direct impact of immunological pathogenesis in FD by developing abnormal autoimmune biomarkers. To the best of our knowledge, this is the first study investigating HLA status of FD patients; therefore further studies are needed to elucidate the underlying mechanism of action.
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Affiliation(s)
- Merve Emecen Sanli
- Department of Pediatrics, Division of Inborn Errors of Metabolism, Istanbul Basaksehir City Hospital, Gazi University Medical Faculty, Ankara, Türkiye
| | - Ayse Kilic
- Department of Pediatrics, Division of Inborn Errors of Metabolism, Istanbul Basaksehir City Hospital, Gazi University Medical Faculty, Ankara, Türkiye
| | - Asli Inci
- Department of Pediatrics, Division of Inborn Errors of Metabolism, Istanbul Basaksehir City Hospital, Gazi University Medical Faculty, Ankara, Türkiye
| | - Ilyas Okur
- Department of Pediatrics, Division of Inborn Errors of Metabolism, Istanbul Basaksehir City Hospital, Gazi University Medical Faculty, Ankara, Türkiye
| | - Fatih Ezgu
- Department of Pediatrics, Division of Inborn Errors of Metabolism, Istanbul Basaksehir City Hospital, Gazi University Medical Faculty, Ankara, Türkiye
| | - Leyla Tumer
- Department of Pediatrics, Division of Inborn Errors of Metabolism, Istanbul Basaksehir City Hospital, Gazi University Medical Faculty, Ankara, Türkiye
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Bothou C, Beuschlein F, Nowak A. Endocrine disorders in patients with Fabry disease: insights from a reference centre prospective study. Endocrine 2022; 75:728-739. [PMID: 34751898 PMCID: PMC8888367 DOI: 10.1007/s12020-021-02918-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/18/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT Fabry Disease (FD) is a rare X-linked storage disease characterised by a-galactosidase A deficiency and diffuse organ accumulation of glycosphingolipids. Enzyme replacement and chaperone therapies are only partially effective. It remains unclear if FD-related endocrine disorders contribute to the observed morbidity. OBJECTIVE To investigate the function of the endocrine system in patients with FD. DESIGN We conducted an observational prospective study from 2017 to 2020. SETTING AND PATIENTS We included 77 patients with genetically confirmed FD (27 men, 20/27 Classic, 7/26 Late Onset phenotype, 50 women, 41/50 and 9/50 respectively), who are systematically followed by our reference centre. RESULTS 36/77 (46.8%) patients had VitD deficiency (25(0H)VitD <20 μg/L) despite the fact that 19/36 (52.8%) were substituted with cholecalciferol. Only 21/77 (27.3%) patients had normal VitD levels without VitD substitution. 11/77 (14.3%) had significant hypophosphatemia (p < 0.80 mmol/L). Three new cases (3.9%) of subclinical, two (2.6%) of overt and six (7.8%) of known hypothyroidism were identified. Of note, men had significantly higher renin levels than women [61.4 (26.1-219.6) vs.25.4 (10.9-48.0) mU/L, p = 0.003]. There were no major abnormalities in adrenal, growth and sex-hormone axes. Patients of Classic phenotype had significantly higher High-Density Lipoprotein Cholesterol (HDL-C) levels (p = 0.002) and in men those levels were positively correlated with globotriaosylsphingosin (Lyso-Gb3) values. 10/77 (13%) of the patients were underweight. CONCLUSIONS VitD supplementation should be considered for all patients with FD. Thyroid screening should be routinely performed. Malnutrition should be prevented or treated, particularly in Classic phenotype patients. Overall, our data suggest that FD specialists should actively seek and diagnose endocrine disorders in their patients.
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Affiliation(s)
- Christina Bothou
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ) and University of Zurich (UZH), Zürich, Switzerland
| | - Felix Beuschlein
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ) and University of Zurich (UZH), Zürich, Switzerland
| | - Albina Nowak
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ) and University of Zurich (UZH), Zürich, Switzerland.
- Department of Internal Medicine, Psychiatry University Hospital Zurich, Zürich, Switzerland.
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Papaxanthos-Roche A, Maillard A, Chansel-Debordeaux L, Albert M, Patrat C, Lidove O, Germain DP, Perez P, Lacombe D. Semen and male genital tract characteristics of patients with Fabry disease: the FERTIFABRY multicentre observational study. Basic Clin Androl 2019; 29:7. [PMID: 31123589 PMCID: PMC6518714 DOI: 10.1186/s12610-019-0088-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/15/2019] [Indexed: 12/27/2022] Open
Abstract
Background Fabry disease (FD) is a rare disorder caused by the deficient activity of α-galactosidase A (α-Gal A). This enzymatic deficit results in the cellular accumulation of globotriaosylceramide (GL-3 or Gb3) and related glycosphingolipids in practically all organs and tissues in the body. The identification of deposits of Gb3 at the reproductive tract level suggests that this part of the body might be involved. We undertook this study to assess the impact of Fabry disease in male gonadal function. Materials and methods This was a multicentre cross-sectional, prospective study that included patients aged 18 to 65 years with Fabry disease, receiving care in a specialized institution. The prevalence of at least one abnormal category in the semen analysis was presented with 95% confidence intervals (CI). The association between infertility and semen analysis abnormality was assessed by Fisher’s exact test. The association of factors associated with fertility or semen analysis abnormality were analysed by a multivariable logistic regression model and expressed by an odds ratio (OR) and its bilateral 95% CI. Results Overall, 14 (82.4% [95% CI, 56.6–96.2]) of the patients had at least one abnormal category in the semen analysis based on WHO criteria. Sixteen patients responded to the questionnaire on fertility, 11 of whom were classified as fertile. Nine of the 11 fertile patients presented at least one abnormal category in the semen analysis. No association was found between infertility and semen analysis abnormality (p = 1.0000). Age of patient at inclusion (OR, 1.19; 95% CI, 0.98 to 1.45; p = 0.0854) and duration of replacement therapy (OR, 1.28; 95% CI, 0.96 to 1.65; p = 0.1263) were associated with sperm abnormalities. Eleven of the 16 patients had a normal hormonal profile. An ultrasound anomaly of the genital tract was observed in 12 patients. Conclusions These results suggest that, while FD might have a detrimental effect on the semen characteristics, the reproductive function diminished only slightly. Further studies are warranted to assess the impact of the disease and of sperm abnormalities in the fertility of male patients with FD.
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Affiliation(s)
- Aline Papaxanthos-Roche
- 1Reproductive biology laboratory-CECOS, Centre Aliénor d'Aquitaine, Hôpital Pellegrin CHU de Bordeaux, F-33000 Bordeaux, France
| | - Aline Maillard
- 2Methodology and data management centre, USMR Unit, CHU de Bordeaux, F-33000 Bordeaux, France
| | - Lucie Chansel-Debordeaux
- 1Reproductive biology laboratory-CECOS, Centre Aliénor d'Aquitaine, Hôpital Pellegrin CHU de Bordeaux, F-33000 Bordeaux, France
| | - Martine Albert
- Reproductive biology unit, Centre Hospitalier Intercommunal Poissy/St-Germain-en-Laye, F-78300 Poissy, France.,4UFR Université de Versailles St Quentin-en-Yvelines, F-78000 Versailles, France
| | - Catherine Patrat
- 5Histology, embriology, reproductive biology unit, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, F-75014 Paris, France
| | - Olivier Lidove
- Internal medicine department, Hôpital La Croix St-Simon, F-75020 Paris, France.,7Sorbonne Universités UPMC, F-75005 Paris, France.,8INSERM CNRS, Centre de recherche en Biologie, GH Pitié Salpêtriere, F-75013 Paris, France
| | - Dominique P Germain
- French Reference Centre for Fabry disease, Division of Medical Genetics Unit, CHU Raymond Poincaré, F-92380 Garches, France.,Inserm U1179, F-78180 Montigny-le-Bretonneux, France
| | - Paul Perez
- 2Methodology and data management centre, USMR Unit, CHU de Bordeaux, F-33000 Bordeaux, France
| | - Didier Lacombe
- 11Medical Genetics Departement, CHU de Bordeaux, INSERM U1211, F-33076 Bordeaux Cedex, France
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Nistal M, Paniagua R, González-Peramato P, Reyes-Múgica M. Perspectives in Pediatric Pathology, Chapter 21. Testicular Pathology in Heritable Metabolic Disease. Pediatr Dev Pathol 2017; 19:371-382. [PMID: 25361068 DOI: 10.2350/14-06-1519-pb.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Inborn errors of metabolism have wide and profound effects in many or all organs, and especially so in those with endocrine functions. The testes are greatly affected by systemic metabolic disorders, leading to specific histological findings that generally reveal the nature of the underlying disorder. Here we describe the main testicular changes seen in the setting of metabolic disease.
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Affiliation(s)
- Manuel Nistal
- 1 Department of Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo No. 2, Madrid 28029, Spain
| | - Ricardo Paniagua
- 2 Department of Cell Biology, Universidad de Alcala, Madrid, Spain
| | - Pilar González-Peramato
- 1 Department of Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo No. 2, Madrid 28029, Spain
| | - Miguel Reyes-Múgica
- 3 Department of Pathology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, One Children's Hospital Drive, 4401 Penn Avenue, Pittsburgh, PA 15224, USA
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Abstract
Lysosomes are cytoplasmic organelles that contain a variety of different hydrolases. A genetic deficiency in the enzymatic activity of one of these hydrolases will lead to the accumulation of the material meant for lysosomal degradation. Examples include glycogen in the case of Pompe disease, glycosaminoglycans in the case of the mucopolysaccharidoses, glycoproteins in the cases of the oligosaccharidoses, and sphingolipids in the cases of Niemann-Pick disease types A and B, Gaucher disease, Tay-Sachs disease, Krabbe disease, and metachromatic leukodystrophy. Sometimes, the lysosomal storage can be caused not by the enzymatic deficiency of one of the hydrolases, but by the deficiency of an activator protein, as occurs in the AB variant of GM2 gangliosidosis. Still other times, the accumulated lysosomal material results from failed egress of a small molecule as a consequence of a deficient transporter, as in cystinosis or Salla disease. In the last couple of decades, enzyme replacement therapy has become available for a number of lysosomal storage diseases. Examples include imiglucerase, taliglucerase and velaglucerase for Gaucher disease, laronidase for Hurler disease, idursulfase for Hunter disease, elosulfase for Morquio disease, galsulfase for Maroteaux-Lamy disease, alglucosidase alfa for Pompe disease, and agalsidase alfa and beta for Fabry disease. In addition, substrate reduction therapy has been approved for certain disorders, such as eliglustat for Gaucher disease. The advent of treatment options for some of these disorders has led to newborn screening pilot studies, and ultimately to the addition of Pompe disease and Hurler disease to the Recommended Uniform Screening Panel (RUSP) in 2015 and 2016, respectively.
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Affiliation(s)
- Carlos R. Ferreira
- Division of Genetics and Metabolism, Children’s National Health System, Washington, DC, USA
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
- Human Biochemical Genetics Section, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - William A. Gahl
- Human Biochemical Genetics Section, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
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Laney DA, Clarke V, Foley A, Hall EW, Gillespie SE, Holida M, Simmons M, Wadley A. The Impact of Fabry Disease on Reproductive Fitness. JIMD Rep 2017; 37:85-97. [PMID: 28324326 PMCID: PMC5740039 DOI: 10.1007/8904_2017_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 02/02/2017] [Accepted: 02/21/2017] [Indexed: 01/24/2023] Open
Abstract
Fabry disease (FD) is a pan-ethnic, X-linked, progressive lysosomal storage disorder caused by pathogenic mutations in the GLA gene. Published case reports and abstracts suggest that decreased reproductive fitness may occur in males with FD. In order to understand the impact of FD on reproductive fitness and increase the accuracy of reproductive genetic counseling, this study examines a large, multi-centered population of individuals with FD to determine if males have reduced reproductive fitness. Study data were collected on 376 patients through two, gender-specific surveys distributed across the United States and Canada. The number of biological live-born children among individuals with FD was compared to statistics from the general population. Information was also collected on reduced sperm count, depression, pain, use of assisted reproductive technology, and reproductive choice. On average, females affected by FD had more biological live-born children (1.8) than males affected by FD (1.1). However, males affected by FD had an increased mean number of biological children (1.1) compared to the mean number of biological children fathered by men in the United States (0.9). Sixteen of the 134 males with FD reported oligospermia, which suggests that an infertility work up may be indicated for males having difficulty impregnating their partners. In our large multicenter sample, males and females with FD do not exhibit reduced reproductive fitness; on average they have more biological children than the general population in the United States. This information should assist clinicians in providing accurate reproductive genetic counseling and treatment for individuals with FD.
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Affiliation(s)
- Dawn A. Laney
- Division of Medical Genetics, Department of Human Genetics, Emory University School of Medicine, 2165 North Decatur Road, Decatur, GA 30033 USA
| | - Virginia Clarke
- Neurology Department, Massachusetts General Hospital, Boston, MA USA
| | - Allison Foley
- Division of Medical Genetics, Department of Human Genetics, Emory University School of Medicine, 2165 North Decatur Road, Decatur, GA 30033 USA
| | - Eric W. Hall
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA USA
| | - Scott E. Gillespie
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA
| | - Myrl Holida
- Division of Medical Genetics, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA USA
| | - Morgan Simmons
- Division of Medical Genetics, Department of Human Genetics, Emory University School of Medicine, 2165 North Decatur Road, Decatur, GA 30033 USA
| | - Alexandrea Wadley
- University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
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Maione L, Tortora F, Modica R, Ramundo V, Riccio E, Daniele A, Belfiore MP, Colao A, Pisani A, Faggiano A. Pituitary function and morphology in Fabry disease. Endocrine 2015; 50:483-8. [PMID: 25896551 DOI: 10.1007/s12020-015-0604-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 04/12/2015] [Indexed: 11/25/2022]
Abstract
Endocrine abnormalities are known to affect patients with Fabry disease (FD). Pituitary gland theoretically represents an ideal target for FD because of high vascularization and low proliferation rate. We explored pituitary morphology and function in a cohort of FD patients through a prospectic, monocentric study at an Academic Tertiary Center. The study population included 28 FD patients and 42 sex and age-matched normal subjects. The protocol included a contrast enhancement pituitary MRI, the assessment of pituitary hormones, anti-pituitary, and anti-hypothalamus antibodies. At pituitary MRI, an empty sella was found in 11 (39%) FD patients, and in 2 (5%) controls (p < 0.001). Pituitary volume was significantly smaller in FD than in controls (p < 0.001). Determinants of pituitary volume were age and alpha-galactosidase enzyme activity. Both parameters resulted independently correlated at multivariate analysis. Pituitary function was substantially preserved in FD patients. Empty sella is a common finding in patients with FD. The major prevalence in the elderly supports the hypothesis of a progressive pituitary shrinkage overtime. Pituitary function seems not to be impaired in FD. An endocrine workup with pituitary hormone assessment should be periodically performed in FD patients, who are already at risk of cardiovascular complications.
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Affiliation(s)
- Luigi Maione
- Section of Endocrinology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
| | - Fabio Tortora
- Institute of Clinical and Experimental Medicine, "F. Magrassi - A. Lanzara", Dipartimento di Diagnostica per Immagini, Second University of Naples, Naples, Italy
| | - Roberta Modica
- Section of Endocrinology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Valeria Ramundo
- Section of Endocrinology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Eleonora Riccio
- Department of Nephrology, University of Naples Federico II, Naples, Italy
| | - Aurora Daniele
- Dipartimento di Scienze e Tecnologie Ambientali Biologiche Farmaceutiche, Second University of Naples, Naples, Italy
| | - Maria Paola Belfiore
- Institute of Clinical and Experimental Medicine, "F. Magrassi - A. Lanzara", Dipartimento di Diagnostica per Immagini, Second University of Naples, Naples, Italy
| | - Annamaria Colao
- Section of Endocrinology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Antonio Pisani
- Department of Nephrology, University of Naples Federico II, Naples, Italy
| | - Antongiulio Faggiano
- Section of Endocrinology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
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Lacombe D, Germain D, Papaxanthos-Roche A. Azoospermie : un nouveau signe d’appel de la maladie de Fabry. Rev Med Interne 2010; 31 Suppl 2:S214-6. [DOI: 10.1016/s0248-8663(10)70014-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Fabry disease, an X-linked disorder of glycosphingolipids that is caused by the deficiency of alpha-galactosidase A, is associated with dysfunction of many cell types and includes a systemic vasculopathy. As a result, patients have a markedly increased risk of developing small-fiber peripheral neuropathy, stroke, myriad cardiac manifestations and chronic renal disease. Virtually all complications of Fabry disease are non-specific in nature and clinically indistinguishable from similar abnormalities that occur in the context of more common disorders in the general population. Although Fabry disease was originally thought to be very rare, recent studies have found a much higher incidence of mutations of the GLA gene, suggesting that this disorder is under-diagnosed. Although the etiology of Fabry disease has been known for many years, the mechanism by which the accumulating alpha-D-galactosyl moieties cause this multi-organ disorder has only recently been studied and is yet to be completely elucidated. Specific therapy for Fabry disease has been developed in the last few years but its role in the management of the disorder is still being investigated. Fortunately, standard 'non-specific' medical and surgical therapy is effective in slowing deterioration or compensating for organ failure in patients with Fabry disease. All these aspects are discussed in detail in the present review.
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Affiliation(s)
- Raphael Schiffmann
- Institute of Metabolic Disease, Baylor Research Institute, 3812 Elm Street, Dallas, TX 75226, USA.
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Takao M, Mori T, Orikasa H, Oh H, Suzuki K, Koto A, Yamazaki K. Postmortem diagnosis of Fabry disease with acromegaly and a unique vasculopathy. Virchows Arch 2007; 451:721-7. [PMID: 17624552 DOI: 10.1007/s00428-007-0456-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Revised: 08/08/2006] [Accepted: 08/29/2006] [Indexed: 01/24/2023]
Abstract
A 44-year-old Japanese man with elevated growth hormone levels and gradual deterioration of mental and renal function was admitted to the hospital. With his deteriorated general condition and renal failure, the patient developed pulmonary thromboembolism and died of respiratory failure. Autopsy examination was conducted, which revealed abnormal accumulation or intracytoplasmic storage of lipid-rich material in the small blood vessels, kidney, heart, and nervous system. After postmortem pathologic studies, including light-microscopic histochemistry, electron microscopy, and biochemical analysis of the stored lipid contents, a final diagnosis of Fabry disease was made. Histopathologic examination revealed a unique vasculopathy characterized by the presence of abnormal intracytoplasmic lipid inclusions and vascular remodeling. With regard to the clinical presentation of acromegaly, hyperplasia but not adenomatous transformation of the acidophils of the anterior pituitary gland with immunohistochemical detection of growth hormone within the cells was noted. In this case, the complication of acromegaly with hyperplasia of the acidophilic cells of the anterior pituitary gland and the unique vasculopathy causing significant organ failure, mainly of the kidney, heart, and central nervous systems, possibly as a result of microcirculatory failure, are considered to be not incidental findings but to be intimately involved in the pathogenesis of Farby disease.
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Affiliation(s)
- Masaki Takao
- Department of Pathology, Saiseikai Central Hospital, l-4-17 Mita, Minato-ku, Tokyo, 108-0073, Japan
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Cornwall GA, von Horsten HH, Swartz D, Johnson S, Chau K, Whelly S. Extracellular quality control in the epididymis. Asian J Androl 2007; 9:500-7. [PMID: 17589787 DOI: 10.1111/j.1745-7262.2007.00309.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The epididymal lumen represents a unique extracellular environment because of the active sperm maturation process that takes place within its confines. Although much focus has been placed on the interaction of epididymal secretory proteins with spermatozoa in the lumen, very little is known regarding how the complex epididymal milieu as a whole is maintained, including mechanisms to prevent or control proteins that may not stay in their native folded state following secretion. Because some misfolded proteins can form cytotoxic aggregate structures known as amyloid, it is likely that control/surveillance mechanisms exist within the epididymis to protect against this process and allow sperm maturation to occur. To study protein aggregation and to identify extracellular quality control mechanisms in the epididymis, we used the cystatin family of cysteine protease inhibitors, including cystatin-related epididymal spermatogenic and cystatin C as molecular models because both proteins have inherent properties to aggregate and form amyloid. In this chapter, we present a brief summary of protein aggregation by the amyloid pathway based on what is known from other organ systems and describe quality control mechanisms that exist intracellularly to control protein misfolding and aggregation. We then present a summary of our studies of cystatin-related epididymal spermatogenic (CRES) oligomerization within the epididymal lumen, including studies suggesting that transglutaminase cross-linking may be one mechanism of extracellular quality control within the epididymis.
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Affiliation(s)
- Gail A Cornwall
- Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, 3601 4th Street, Lubbock, TX 79430, USA.
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Papaxanthos-Roche A, Deminière C, Bauduer F, Hocké C, Mayer G, Lacombe D. Azoospermia as a new feature of Fabry disease. Fertil Steril 2007; 88:212.e15-8. [PMID: 17261284 DOI: 10.1016/j.fertnstert.2006.11.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Revised: 11/09/2006] [Accepted: 11/09/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To describe two cases of azoospermia in men with Fabry disease. DESIGN Case report. SETTING Centre hospitalier universitaire, maternité Pellegrin, Bordeaux, France. PATIENT(S) Two infertile men with azoospermia and with Fabry disease. INTERVENTION Testicular biopsies. MAIN OUTCOME MEASURE Histological and electron microscopy analysis of testicular biopsies. RESULT(S) Testicular biopsies revealed characteristic aspects of trihexosid ceramid deposits in Leydig cells by optical and electronic microscopic analysis. Using testicular sperm extraction and intracytoplasmic sperm injection, sperm retrieval led to pregnancies and deliveries of healthy children. CONCLUSION(S) Azoospermia should be considered as a possible complication of Fabry disease. We recommend a routine sperm analysis in the follow-up of young patients with Fabry disease. Azoospermia was still present after 4 years of agalsidase-beta therapy. Because we do not know the efficacy of agalsidase therapy on the genital involvement in Fabry disease, sperm cryopreservation is recommended.
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Affiliation(s)
- Aline Papaxanthos-Roche
- Laboratoire de Biologie de la Reproduction, Centre Hospitalier Universitaire Maternité Pellegrin, Bordeaux, France.
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Faggiano A, Pisani A, Milone F, Gaccione M, Filippella M, Santoro A, Vallone G, Tortora F, Sabbatini M, Spinelli L, Lombardi G, Cianciaruso B, Colao A. Endocrine dysfunction in patients with Fabry disease. J Clin Endocrinol Metab 2006; 91:4319-25. [PMID: 16926253 DOI: 10.1210/jc.2006-0858] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Fabry disease (FD) is a genetic disorder caused by lysosomal alpha-galactosidase-A deficiency and is characterized by the systemic accumulation of globotriaosylceramide. All endocrine glands are susceptible to globotriaosylceramide accumulation because of their high vascularization and low cellular proliferation rate. Nevertheless, this endocrine system has never been investigated in detail. OBJECTIVE We aimed to investigate the function and morphology of the endocrine glands in FD. PATIENTS The thyroid, gonadal, adrenal, and GH/IGF-I axes were evaluated in 18 FD patients (nine females and nine males, aged 21-64 yr) and 18 sex- and age-matched healthy subjects. STUDY DESIGN We conducted an observational, analytical, open, prospective study. INTERVENTIONS Ten of the 18 patients received enzyme replacement therapy (ERT) with recombinant human alpha-galactosidase-A (agalsidase beta) at a dose of 1 mg/kg body weight every 2 wk. RESULTS FD patients had higher baseline TSH levels than controls (P < 0.01). Three subjects were diagnosed with an early stage of subclinical primary hypothyroidism associated with negative antithyroid antibodies. A history of menses abnormalities, miscarriage, or assisted delivery was found in 89% of FD women. Asthenozoospermia, oligozoospermia, or both were found in all FD men through seminal fluid analysis. FD patients had significantly higher circulating ACTH and lower cortisol levels than controls (P < 0.05). In patients under ERT, a suboptimal cortisol response to the 250-microg ACTH test was found in 10%, and the ACTH-stimulated cortisol peak was significantly correlated to the health status profile (P < 0.05). CONCLUSION A variety of latent endocrine dysfunctions, including life-threatening conditions, occur in patients with FD. Endocrine dysfunctions are also present in patients already receiving ERT and are in part related to their persistent poor quality of life. An endocrine work-up should be recommended in all FD patients. Adequate monitoring and hormonal therapy, when required, have to be performed in cases of subclinical endocrine dysfunction to avoid life-threatening events.
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Affiliation(s)
- A Faggiano
- Department of Molecular, Federico II University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
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Nistal M, Regadera J, Winitzky P, Tejerina E, Chemes H. Granular changes in Sertoli cells in children and pubertal patients. Fertil Steril 2005; 83:1489-99. [PMID: 15866589 DOI: 10.1016/j.fertnstert.2004.12.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2004] [Revised: 12/10/2004] [Accepted: 12/10/2004] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To characterize lysosomes and histochemical function of granular Sertoli cells in developmental alterations. DESIGN Prospective and retrospective study. SETTING University hospital and research centers. PATIENT(S) Nineteen infantile and pubertal patients undergoing testicular biopsy; four rat testes for lysosomal study. INTERVENTION(S) CD-68, alpha-1-antitrypsin, vimentin, inhibin alpha subunit, and anti-mullerian hormone antibodies were evaluated. Morphometric measures in seminiferous tubules with and without granular Sertoli cells were obtained. Ultrastructural data of lysosomes in human and rat Sertoli cells were compared. MAIN OUTCOME MEASURE(S) Quantification of mean diameter of seminiferous tubules, tubular fertility index, and germ and Sertoli cell indexes were obtained in human testis. RESULT(S) Granular changes in Sertoli cells are due to the accumulation of large amounts of lysosomes. Vimentin immunoexpression in infantile and pubertal granular Sertoli cells was lower than in adjacent nongranular Sertoli cells. Inhibin was negative in granular cells. Anti-mullerian hormone-positive and -negative granular Sertoli cells were present within the same tubules. CONCLUSION(S) The presence of early granular changes in Sertoli cells in childhood and pubertal cryptorchidic patients, associated with other developmental alterations, suggests an intense and irreversible dysfunction of phagocytosis in the granular Sertoli cells. These alterations might be considered primary and irreversible anomalies of Sertoli cells, which might be contributing factors in the infertility seen in these patients.
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Affiliation(s)
- Manuel Nistal
- Department of Morphology, Autonoma University of Madrid, Madrid, Spain.
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Hauser AC, Gessl A, Harm F, Wiesholzer M, Kleinert J, Wallner M, Voigtländer T, Bieglmayer C, Sunder-Plassmann G. Hormonal profile and fertility in patients with Anderson-Fabry disease. Int J Clin Pract 2005; 59:1025-8. [PMID: 16115176 DOI: 10.1111/j.1742-1241.2005.00620.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Anderson-Fabry disease is a glycosphingolipid storage disorder with an X-linked recessive inheritance. The alpha-galactosidase A deficiency leads to a progressive accumulation of globotriaosylceramide in the endothelium and tissue cells of various organs. The kidney, heart and brain are predominantly affected. Reports on endocrine function and fertility rates in patients with Anderson-Fabry disease are sparse. In the present study, we assessed ovarian, testicular and adrenal function in a cohort of patients with Anderson-Fabry disease. Plasma follicle-stimulating hormone, luteinizing hormone, prolactin, estradiol, testosterone, sex hormone-binding globulin, somatotropin, insulin-like growth factor-I and serum cortisol were measured in 13 patients (six female and seven male), currently observed in an outpatient clinic. The profile revealed an undisturbed hormonal function and a normal fertility rate in both male and female Anderson-Fabry patients when compared with the corresponding Austrian population.
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Affiliation(s)
- A C Hauser
- Division of Nephrology and Dialysis,Medical University of Vienna, Vienna, Austria.
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Elleder M. Sequelae of storage in Fabry disease--pathology and comparison with other lysosomal storage diseases. Acta Paediatr 2003; 92:46-53; discussion 45. [PMID: 14989466 DOI: 10.1111/j.1651-2227.2003.tb00222.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the sequelae of the lysosomal storage of globotriaosylceramide (Gb3) in a series of patients with Fabry disease. METHODS Biopsy and post-mortem samples from 12 patients with Fabry disease were examined microscopically, including, in some cases, immunohistochemistry and electron microscopy. Where possible, comparisons were made with other lysosomal storage disorders. RESULTS Storage of Gb3 in cardiocytes leads commonly to progressive hypertrophy, which is a non-specific phenomenon also observed in other lysosomal storage disorders. Capillary endothelial storage was associated with a tendency for capillary basement membrane multiplication. In the single angiokeratoma studied, the basement membrane was rudimentary. Sinusoids in the adrenal cortex and liver displayed either a slight degree of storage or were unaffected. The glomeruli of the kidney exhibited focal hyalinization starting in the mesangial region. Proximal tubular cells were essentially free of lysosomal accumulation, including protein absorption droplets, despite the presence of proteinuria. In only one case, an autopsied Fabry heterozygote, were the proximal tubular cells loaded with protein absorption droplets. The arterial wall in large muscular arteries (coronary, renal and intrarenal) displayed arteriopathy with pronounced involvement of the smooth muscle cells in the media. Arteriopathy started with storage, followed by cell degeneration and breakdown, extracellular matrix deposition and, often, calcification (confined to the muscular layer). Smooth muscle cells occasionally exhibited shrinkage-type necrosis, with dispersion of the stored lipid into the dense cytoplasmic mass. Intimal and mitral valve fibroblasts exhibited variable storage, which was associated with cell loss and necrosis. Intensive storage was found in Leydig cells and in the epididymal epithelium. CONCLUSION These long-term sequelae of Gb3 storage are mostly irreversible. Some may interfere with enzyme replacement therapy. It is important, therefore, to consider starting enzyme replacement therapy as early as possible.
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Affiliation(s)
- M Elleder
- Institute of Inherited Metabolic Disorders, Charles University 1st Faculty of Medicine and University Hospital Prague, Prague, Czech Republic.
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Rune GM, deSouza P, Krowke R, Merker HJ, Neubert D. Morphological and histochemical effects of 2,3,7,8-tetrachlorodibenzo-p dioxin (TCDD) on marmoset (Callithrix jacchus) testes. ARCHIVES OF ANDROLOGY 1991; 26:143-54. [PMID: 1872647 DOI: 10.3109/01485019108987637] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The testes of marmosets (Callithrix jacchus), which had been treated with a single dose of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) (0.3 microgram to 10 micrograms/l kg body weight (BW)) were studied after 7 days using morphological and histochemical techniques. Light microscopic and electron microscopic examination revealed decreased intercellular contact in the germinal epithelium, as indicated first by enlarged intercellular spaces between the Sertoli's cells and between the Sertoli's cells and neighboring germ cells (i.e., spermatogonia and preleptotene spermatocytes), particularly in the basic compartment of the germinal epithelium. Second, decreased intercellular contact was indicated by the accumulation of premature spermatids and spermatocytes in the tubular lumen after TCDD treatment. The Sertoli's cells exhibited an increased amount of lipids, phagolysosomes, and vacuoles in their cytoplasm. Spermatids were frequently affected by TCDD, particularly during early spermiogenesis. These alterations included vacuolization of the cytoplasm and the development of additional germinal vesicles. This special effect on spermiogenesis became even more evident quantitatively by determination and counting of tubular stages in semithin sections. Tubular determination on the basis of the appearance of spermatids revealed that the ratio of tubular stages I to III became lower and that of stages V to VII became higher, dose dependently, indicating a maturation stop at the beginning of spermiogenesis caused by TCDD treatment. After TCDD treatment, Leydig's cells were morphologically unaffected, but histochemical investigations revealed decreased activity of 3 beta-hydroxysteroid dehydrogenase (3 beta-HSD). The sensitivity of the applied methods was different in view of the level of unaffection. The effect of Leydig's cells, as indicated by the decreased activity of 3 beta-HSD, had already been found at a dose of 1 microgram/kg BW TCDD, whereas clear-cut morphological and morphometrical effects were seen at 3 micrograms/kg BW for the first time. Moreover, with the special effect on spermiogenesis in marmoset monkeys, the findings demonstrate that the toxicity of TCDD on testicular morphology is species specific.
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Affiliation(s)
- G M Rune
- Department of Anatomy, Free University of Berlin, Germany
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