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Duro G, Anania M, Zizzo C, Francofonte D, Giacalone I, D’Errico A, Marsana EM, Colomba P. Diagnosis of Fabry Disease Using Alpha-Galactosidase A Activity or LysoGb3 in Blood Fails to Identify Up to Two Thirds of Female Patients. Int J Mol Sci 2024; 25:5158. [PMID: 38791200 PMCID: PMC11121337 DOI: 10.3390/ijms25105158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 05/01/2024] [Indexed: 05/26/2024] Open
Abstract
Anderson-Fabry disease is a lysosomal storage disorder caused by mutations in the GLA gene, which encodes the enzyme α-galactosidase A. The GLA gene is located on the X-chromosome, causing an X-linked pathology: due to lyonization, female patients usually manifest a variable symptomatology, ranging from asymptomatic to severe phenotypes. The confirmation of the clinical diagnosis of Fabry disease, achieved by measuring α-galactosidase A activity, which is usually the first test used, shows differences between male and female patients. This assay is reliable in male patients with causative mutations in the GLA gene, in whom the enzymatic activity is lower than normal values; on the other hand, in female Fabry patients, the enzymatic activity is extremely variable between normal and pathological values. These fluctuations are also found in female patients' blood levels of globotriaosylsphingosine (LysoGb3) for the same reason. In this paper, we present a retrospective study conducted in our laboratories on 827 Fabry patients with causative mutations in the GLA gene. Our results show that 100% of male patients had α-galactosidase A activity below the reference value, while more than 70% of female patients had normal values. It can also be observed that almost half of the female patients with pathogenic mutations in the GLA gene showed normal values of LysoGb3 in blood. Furthermore, in women, blood LysoGb3 values can vary over time, as we show in a clinical case presented in this paper. Both these tests could lead to missed diagnoses of Fabry disease in female patients, so the analysis of the GLA gene represents the main diagnostic test for Fabry disease in women to date.
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Affiliation(s)
| | | | | | | | | | | | | | - Paolo Colomba
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), 90146 Palermo, Italy; (G.D.); (M.A.); (C.Z.); (D.F.); (I.G.); (A.D.); (E.M.M.)
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2
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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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Cordeiro RA, Rosa Neto NS, Giardini HAM. What should rheumatologists know about Gaucher disease and Fabry disease? Connecting the dots for an overview. Adv Rheumatol 2024; 64:22. [PMID: 38520029 DOI: 10.1186/s42358-024-00362-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024] Open
Abstract
Gaucher and Fabry diseases are lysosomal storage disorders in which deficient enzyme activity leads to pathological accumulation of sphingolipids. These diseases have a broad phenotypic presentation. Musculoskeletal symptoms and pain complaints are frequently reported by patients. Thus, rheumatologists can be contacted by these patients, contributing to the correct diagnosis, earlier indication of appropriate treatment and improvement of their prognosis. This review describes important concepts about Gaucher and Fabry diseases that rheumatologists should understand to improve patients' quality of life and change the natural history of these diseases.
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Affiliation(s)
- Rafael Alves Cordeiro
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, 455, 3 andar, sala 3184, Cerqueira Cesar, Sao Paulo, SP, CEP 01246-903, Brazil.
| | - Nilton Salles Rosa Neto
- Centro de Doenças Raras e da Imunidade, Hospital Nove de Julho, São Paulo, Brazil
- Universidade Santo Amaro, São Paulo, Brazil
| | - Henrique Ayres Mayrink Giardini
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, 455, 3 andar, sala 3184, Cerqueira Cesar, Sao Paulo, SP, CEP 01246-903, Brazil
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4
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Whitlock RH, Nour-Mohammadi M, Curtis S, Komenda P, Bohm C, Collister D, Tangri N, Rigatto C. Magnitude of the Potential Screening Gap for Fabry Disease in
Manitoba: A Population-Based Retrospective Cohort Study. Can J Kidney Health Dis 2023; 10:20543581231162218. [PMID: 36970566 PMCID: PMC10031591 DOI: 10.1177/20543581231162218] [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: 10/19/2022] [Accepted: 01/28/2023] [Indexed: 03/24/2023] Open
Abstract
Background: Fabry disease is a rare disorder caused by the deficient activity of
α-galactosidase A (GLA) that often leads to organ damage. Fabry disease can
be treated with enzyme replacement or pharmacological therapy, but due to
its rarity and nonspecific manifestations, it often goes undiagnosed. Mass
screening for Fabry disease is impractical; however, a targeted screening
program for high-risk individuals may uncover previously unknown cases. Objective: Our objective was to use population-level administrative health databases to
identify patients at high risk of Fabry disease. Design: Retrospective cohort study. Setting: Population-level health administrative databases housed at the Manitoba
Centre for Health Policy. Patients: All residents of Manitoba, Canada, between 1998 and 2018. Measurements: We ascertained the evidence of GLA testing in a cohort of patients at high
risk of Fabry disease. Methods: Individuals without a hospitalization or prescription indicative of Fabry
disease were included if they had evidence of 1 of 4 high-risk conditions
for Fabry disease: (1) ischemic stroke <45 years of age, (2) idiopathic
hypertrophic cardiomyopathy, (3) proteinuric chronic kidney disease or
kidney failure of unknown cause, or (4) peripheral neuropathy. Patients were
excluded if they had known contributing factors to these high-risk
conditions. Those who remained and had no prior GLA testing were assigned a
0% to 4.2% probability of having Fabry disease depending on their high-risk
condition and sex. Results: After applying exclusion criteria, 1386 individuals were identified as having
at least 1 high-risk clinical condition for Fabry disease in Manitoba. There
were 416 GLA tests conducted during the study period, and of those, 22 were
conducted in individuals with at least 1 high-risk condition. This leaves a
screening gap of 1364 individuals with a high-risk clinical condition for
Fabry disease in Manitoba who have not been tested. At the end of the study
period, 932 of those individuals were still alive and residing in Manitoba,
and if screened today, we expect between 3 and 18 would test positive for
Fabry disease. Limitations: The algorithms we used to identify our patients have not been validated
elsewhere. Diagnoses of Fabry disease, idiopathic hypertrophic
cardiomyopathy, and peripheral neuropathy were only available via
hospitalizations and not physician claims. We were only able to capture GLA
testing processed through public laboratories. Patients identified to be at
high risk of Fabry disease by the algorithm did not undergo GLA testing due
to a clinical rationale that we were unable to capture. Conclusions: Administrative health databases may be a useful tool to identify patients at
higher risk of Fabry disease or other rare conditions. Further directions
include designing a program to screen high-risk individuals for Fabry
disease as identified by our administrative data algorithms.
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Affiliation(s)
- Reid H. Whitlock
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
- Reid H. Whitlock, Chronic Disease
Innovation Centre, Seven Oaks General Hospital, 2LB19-2300 McPhillips Street,
Winnipeg, MB R2V 3M3, Canada.
| | - Mohammad Nour-Mohammadi
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
- Department of Internal Medicine,
University of Manitoba, Winnipeg, Canada
| | - Sarah Curtis
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Paul Komenda
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
- Department of Internal Medicine,
University of Manitoba, Winnipeg, Canada
| | - Clara Bohm
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
- Department of Internal Medicine,
University of Manitoba, Winnipeg, Canada
| | - David Collister
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
- Department of Medicine, University of
Alberta, Edmonton, Canada
| | - Navdeep Tangri
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
- Department of Internal Medicine,
University of Manitoba, Winnipeg, Canada
| | - Claudio Rigatto
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
- Department of Internal Medicine,
University of Manitoba, Winnipeg, Canada
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Imasawa T, Murayama K, Sawada T, Hirose M, Takayanagi M, Nakamura K. High-risk screening for Fabry disease in hemodialysis patients in Chiba Prefecture, Japan. Clin Exp Nephrol 2023; 27:288-294. [PMID: 36574104 DOI: 10.1007/s10157-022-02295-w] [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: 08/11/2022] [Accepted: 10/30/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND High-risk screening for Fabry disease in dialysis patients is an effective means for reducing the number of undiagnosed cases. However, such screening has not been conducted in Chiba Prefecture, Japan. Herein, we aimed to estimate the prevalence of Fabry disease among patients undergoing hemodialysis in Chiba Prefecture by high-risk screening using α-galactosidase A (αGal A) activity measurement, and examine the hemodialysis effect on αGal A activity. METHODS Patients who underwent maintenance hemodialysis at 25 facilities in Chiba Prefecture were recruited. The αGal A activity was measured using the dried blood spot (DBS) test as the first screening. If the enzyme activity was lower than the cut-off, the second screening was performed with the same method before and after dialysis. RESULTS Overall, 2924 patients (2036 men and 888 women) were included from which 94 cases (45 men and 48 women) showed decreased αGAL activity in the first screening and 3 (two men and one women) in the second screening. Genetic testing was performed in 3 patients, and the c.1078G > A mutation in GLA gene was detected in one male patient (0.03%). There has been a statistically significant decrease in αGal A activity of DBS at post-dialysis compared to that at pre-dialysis (20.5 ± 10.4 pmol/h/disk and 22.7 ± 11.5 pmol/h/disk, p < 0.0001). CONCLUSION The prevalence of Fabry disease among patients undergoing hemodialysis in Chiba Prefecture was estimated as 0.03%. This is the first time that dialysis has been shown to affect the αGal A activity.
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Affiliation(s)
- Toshiyuki Imasawa
- Department of Nephrology, National Hospital Organization Chiba-Higashi National Hospital, 673 Nitona-cho, Chuoh-ku, Chiba, Chiba, 206-8712, Japan.
| | - Kei Murayama
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1, Heta-cho, Midori-ku, Chiba, 266-0007, Japan
| | - Takaaki Sawada
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, , 860-8556, Japan
| | - Masanori Hirose
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Masaki Takayanagi
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1, Heta-cho, Midori-ku, Chiba, 266-0007, Japan
| | - Kimitoshi Nakamura
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, , 860-8556, Japan
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Martin C, Pablo N, Pedro Q, Paula R. Screening for Fabry disease in Argentina in male patients with chronic kidney disease at all stages. J Nephrol 2022; 35:2437-2440. [PMID: 35972684 DOI: 10.1007/s40620-022-01405-x] [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: 05/12/2022] [Accepted: 07/14/2022] [Indexed: 11/28/2022]
Abstract
We report three patients diagnosed with Fabry disease through a screening study which included individuals suffering from chronic kidney disease (CKD) at any stage. The study recruited 1740 male patients, and three Fabry patients were diagnosed, resulting in a frequency of 0.17%. The analysis by CKD stage group revealed frequencies of 3.03%, 0.77% and 0.17%, in CKD1, CKD3 and CKD5, respectively. Pedigree analysis was carried out for these families, with a high ratio index: pedigree (1:16). This study underlines the importance of considering Fabry disease in the differential diagnosis at every stage of CKD, including the early ones, and stresses the possibility of finding patients with late onset phenotypes.
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Affiliation(s)
| | | | | | - Rozenfeld Paula
- AADELFA, La Plata, Argentina. .,Departamento de Ciencias Biológicas, Instituto de Estudios Inmunológicos y Fisiopatológicos (IIFP), UNLP, CONICET, asociado CIC PBA, Facultad de Ciencias Exactas, La Plata, Argentina.
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7
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Abstract
Nonspecific gastrointestinal (GI) symptoms, such as postprandial cramping pain, diarrhea, nausea and vomiting are typical symptoms for irritable bowel syndrome or inflammatory bowel disease, but may also be the first symptoms of Fabry disease (FD). This review focus on GI manifestations in FD, by providing an overview of symptoms, a proper diagnosis, an appropriate management by FD-specific and concomitant medications and lifestyle interventions. We provide comprehensive literature-based data combined with personal experience in the management of FD patients. Since FD is rare and the clinical phenotype is heterogeneous, affected patients are often misdiagnosed. Consequently, physicians should consider FD as a possible differential diagnosis when assessing unspecific GI symptoms. Improved diagnostic tools, such as a modified GI symptom assessment scale can facilitate the diagnosis of FD in patients with GI symptoms of unknown cause and thus enable the timely initiation of a disease-specific therapy. Expansive intravenous enzyme replacement therapy with α-galactosidase A or oral chaperone therapy for patients with amenable mutations improve the disease burden including GI symptoms, but a timely start of therapy is crucial for the prognosis. A special diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) or pro- and prebiotics might improve FD-typical GI symptoms. Furthermore, preliminary success was reported with the oral administration of α-galactosidase A. In addition to a timely initiation of FD-specific therapy, affected patients with GI symptoms might benefit from a FODMAP-low diet, pro- and prebiotics and/or low-cost oral substitution with AGAL to support digestion and reduce dysbiosis.
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Affiliation(s)
- Malte Lenders
- Internal Medicine D, Interdisciplinary Fabry Center Münster (IFAZ), University Hospital Münster, Münster, Germany
| | - Eva Brand
- Internal Medicine D, Interdisciplinary Fabry Center Münster (IFAZ), University Hospital Münster, Münster, Germany,CONTACT Eva Brand Department of Internal Medicine D, and Interdisciplinary Fabry Center (IFAZ), University Hospital Münster, Albert-Schweitzer-Campus 1, MünsterD-48149, Germany
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8
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de Dios García-Díaz J, López-Rodríguez M, Morales-Conejo M, Riera-Mestre A. Understanding the ecosystem of patients with lysosomal storage diseases in Spain: a qualitative research with patients and health care professionals. Orphanet J Rare Dis 2022; 17:17. [PMID: 35031060 PMCID: PMC8760689 DOI: 10.1186/s13023-021-02168-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 12/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background Lysosomal Storage Diseases (LSDs) are a group of Rare Diseases (RDs) caused by lysosomal enzyme deficiencies. Patients with LSDs suffer from a wide range of symptoms with a strong impact in their daily routines. In this study we aimed to explore the impact of the disease on the lives of patients with four LSDs, as well as how they experience Patient Journey from diagnosis to follow up. Unmet Needs (UNs) perceived by patients and clinicians were assessed to have a better understanding of which initiatives could improve LSDs management and especially those that could result in an improvement of patients’ quality of life. Methods Qualitative research was the research methodology selected for the study. It provides plentiful and holistic insights into people’s views and actions. The study was conducted through in-depth face-to-face semi-structured interviews. Results In total, 20 patients and 25 Health Care Professionals (HCPs) from different Spanish regions were interviewed. Patients perceived that the highest impact of the LSDs was on their daily routines, specifically on their emotional side, their work/school environment, their family and their social life. Regarding the Patient Journey experience, the worst perceived stage was the pre-diagnosis, where patients only reported negative perceptions, being the delay in diagnosis and misdiagnosis the most commented issues. On the contrary, the follow-up stage was the one with less negative perceptions. Overall, patients and HCPs agreed on the priority UNs, such as accelerating diagnosis, reducing bureaucracy for the treatment access and a more coordinated attention for the patients, not only among different physicians but also with other professionals such as genetic counselors or social workers. Conclusions Our data shows that there are still UNs to be addressed from the perspective of patients and HCPs. The main UN is accelerating diagnosis, which could be achieved by medical awareness and education, according to clinicians. A more comprehensive disease management was another main point to be worked on to improve LSD-patient experience and quality of life. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-02168-7.
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Affiliation(s)
- Juan de Dios García-Díaz
- Clinical Genetics Unit, Department of Internal Medicine, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
| | | | - Montserrat Morales-Conejo
- Department of Internal Medicine, Hospital Universitario, 12 de Octubre, Madrid, Spain.,CSUR de Errores Congénitos del Metabolismo y miembro adscrito colaborador grupo de Enfermedades Mitocondriales Y Neuromusculares, Madrid, Spain.,Instituto de Investigación Hospital 12 de Octubre. Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Unidad 723, Madrid, Spain
| | - Antoni Riera-Mestre
- Department of Internal Medicine, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
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Giugliani R, Marques S, Andrade LGMD, Pessoa A, Vaisbich MH, Blum A, Tenório F, Rosa Neto NS. Clinical and diagnostic aspects of Fabry disease management: a narrative review with a particular focus on Brazilian experts’ perspectives. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2022. [DOI: 10.1590/2326-4594-jiems-2021-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Roberto Giugliani
- Universidade Federal do Rio Grande do Sul, Brazil; Hospital de Clínicas de Porto Alegre, Brazil
| | | | | | - André Pessoa
- Hospital Infantil Albert Sabin, Brazil; Universidade Estadual do Ceará, Brazil
| | - Maria H. Vaisbich
- Universidade Federal de São Paulo, Brazil; Universidade de São Paulo (HCFMUSP), Brazil
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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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11
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Alkhzouz C, Miclea D, Bucerzan S, Lazea C, Nascu I, Sido PG. Early clinical signs in lysosomal diseases. Med Pharm Rep 2021; 94:S43-S46. [PMID: 34527909 DOI: 10.15386/mpr-2228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background and aim The lysosomal storage diseases are a group of monogenic diseases with multisystemic impairment and chronic progression induced by the deficiency of lysosomal acid hydrolases involved in the breakdown of various macromolecules. The accumulation occurs in the macrophages of the reticule-endothelial system and causes enlargement and functional impairment. The mainly involved organs are the brain, liver, spleen, bones, joints, airways, lungs, and heart. The aim of this study was to evaluate early symptoms, signs and the delay in the diagnosis of different lysosomal diseases. Methods The medical documentation of 188 patients with lysosomal storage disorders, aged 1-70 years, were analyzed. All these patients were specifically diagnosed, by enzyme and molecular assay. Results The age of clinical signs onset varies in different type of lysosomal diseases, from the first months of life or early childhood in severe form, to adulthood in attenuated forms. The delay between the clinical signs onset and specific diagnosis ranged from 0.5 months to 57.91 years. Conclusions The lysosomal storage diseases are rare diseases with childhood onset, but these early signs and symptoms are not recognized and are often taken into account when the vital organs damage becomes manifest.
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Affiliation(s)
- Camelia Alkhzouz
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Center of Expertise for Rare Diseases Lysosomal Diseases, Clinical Emergency Hospital for Children, Cluj, Romania
| | - Diana Miclea
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Center of Expertise for Rare Diseases Lysosomal Diseases, Clinical Emergency Hospital for Children, Cluj, Romania
| | - Simona Bucerzan
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Center of Expertise for Rare Diseases Lysosomal Diseases, Clinical Emergency Hospital for Children, Cluj, Romania
| | - Cecilia Lazea
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Center of Expertise for Rare Diseases Lysosomal Diseases, Clinical Emergency Hospital for Children, Cluj, Romania
| | - Ioana Nascu
- Center of Expertise for Rare Diseases Lysosomal Diseases, Clinical Emergency Hospital for Children, Cluj, Romania
| | - Paula Grigorescu Sido
- Center of Expertise for Rare Diseases Lysosomal Diseases, Clinical Emergency Hospital for Children, Cluj, Romania
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Shields AL, Lamoureux RE, Taylor F, Barth JA, Mulberg AE, Kessler V, Skuban N. FABry Disease Patient-Reported Outcome-GastroIntestinal (FABPRO-GI): A new Fabry disease-specific gastrointestinal outcomes instrument. Qual Life Res 2021; 30:2983-2994. [PMID: 33914257 PMCID: PMC8481178 DOI: 10.1007/s11136-021-02847-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Fabry disease is a rare multisystemic disorder caused by functional deficiency of the lysosomal enzyme alpha-galactosidase A. Gastrointestinal (GI) signs and symptoms are among the earliest clinical manifestations in patients with Fabry disease but are often nonspecific, misdiagnosed, and untreated. No instruments have been developed specifically to assess GI signs and symptoms in Fabry disease. The FABry disease Patient-Reported Outcome-GastroIntestinal (FABPRO-GI) was developed to address this unmet need and is intended for use in clinical trials (24-h FABPRO-GI) and real-world settings (7-day FABPRO-GI). METHODS Findings from a literature review, expert advisory meetings, and patient concept elicitation interviews (CEIs) were summarized into conceptual models. These conceptual models were used to develop preliminary versions of the 24-h and 7-day FABPRO-GI. Cognitive debriefing interviews (CDIs) were conducted with additional patients to assess content validity, including understandability, relevance, and comprehensiveness of the preliminary versions of the 24-h and 7-day FABPRO-GI. RESULTS Literature review (n = 17 articles), expert advisory meetings (n = 5), and patient CEIs (n = 17) identified mostly overlapping Fabry disease-related GI signs and symptoms, including abdominal cramps, bloating, and diarrhea, and informed development of the preliminary 24-h and 7-day FABPRO-GI. CDIs (n = 15) provided evidence of content validity and informed revisions of the 24-h and 7-day FABPRO-GI. CONCLUSION With evidence of content validity, the 24-h and 7-day FABPRO-GI are the first Fabry disease-specific patient-reported outcomes to assess GI signs and symptoms in patients with Fabry disease with potential for use in clinical trials and real-world settings, respectively.
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Affiliation(s)
- Alan L. Shields
- Adelphi Values, 290 Congress Street, 6th Floor, Boston, MA 02210 USA
| | | | - Fiona Taylor
- Adelphi Values, 290 Congress Street, 6th Floor, Boston, MA 02210 USA
| | - Jay A. Barth
- grid.427771.00000 0004 0619 7027Amicus Therapeutics, Inc., Cranbury, NJ USA
| | - Andrew E. Mulberg
- grid.427771.00000 0004 0619 7027Amicus Therapeutics, Inc., Cranbury, NJ USA
| | - Vivian Kessler
- grid.427771.00000 0004 0619 7027Amicus Therapeutics, Inc., Cranbury, NJ USA
| | - Nina Skuban
- grid.427771.00000 0004 0619 7027Amicus Therapeutics, Inc., Cranbury, NJ USA
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13
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Yoshida S, Kido J, Sawada T, Momosaki K, Sugawara K, Matsumoto S, Endo F, Nakamura K. Fabry disease screening in high-risk populations in Japan: a nationwide study. Orphanet J Rare Dis 2020; 15:220. [PMID: 32843101 PMCID: PMC7448968 DOI: 10.1186/s13023-020-01494-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 08/05/2020] [Indexed: 02/06/2023] Open
Abstract
Background Fabry disease (FD) is a X-linked inherited disorder caused by mutations in the GLA gene, which results in the deficiency of α-galactosidase A (α-Gal A). This leads to the progressive accumulation of metabolites, which can cause multisystemic dysfunction. A recent screening study among neonates reported an increase in the incidence of FD, and numerous FD patients remain undiagnosed or even misdiagnosed. Therefore, this study aimed to identify patients with FD by performing high-risk screening in 18,135 individuals, enrolled from October 2006 to March 2019, with renal, cardiac, or neurological manifestations from all prefectures in Japan. A total of 601 hospitals participated in this study. Results Low α-Gal A activity was detected in 846 individuals, with 224 of them diagnosed with FD by GLA sequencing. Cases with a family history of FD (n = 64) were also subjected to sequencing, without α-Gal A assay, as per individual request, and 12 of them were diagnosed with a variant of FD. A total of 236 patients with FD (97 males and 139 females) were identified from among 18,199 participants. A total of 101 GLA variants, including 26 novel variants, were detected in the 236 patients with FD from 143 families, with 39 amenable variants (39%) and 79 of the 236 patients (33%) suitable for migalastat treatment. Conclusions From among 18,199 participants, 101 GLA variants, including 26 novel variants, were identified in the 236 patients with FD from 143 families. Migalastat was identified as a suitable treatment option in 33% of the patients with FD and 39% of the GLA variants were detected as amenable. Therefore, the simple screening protocol using dried blood spots that was performed in this study could be useful for early diagnosis and selection of appropriate treatments for FD in high-risk and underdiagnosed patients with various renal, cardiac, or neurological manifestations.
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Affiliation(s)
- Shinichiro Yoshida
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan.,KM Biologics Co., Ltd., Kumamoto, Japan
| | - Jun Kido
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan.
| | - Takaaki Sawada
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan
| | - Ken Momosaki
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan.,Kumamoto-Ezuko Medical Center for Disabled Children, Kumamoto, Japan
| | - Keishin Sugawara
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan
| | - Shirou Matsumoto
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan
| | - Fumio Endo
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan.,Kumamoto-Ezuko Medical Center for Disabled Children, Kumamoto, Japan
| | - Kimitoshi Nakamura
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan
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14
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Luo Y, Wu D, Shen M. Recurrent fever of unknown origin: An overlooked symptom of Fabry disease. Mol Genet Genomic Med 2020; 8:e1454. [PMID: 32797665 PMCID: PMC7549601 DOI: 10.1002/mgg3.1454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/07/2020] [Accepted: 07/28/2020] [Indexed: 01/01/2023] Open
Abstract
Objective Fabry disease (FD) is a rare X‐linked lysosomal storage disorder due to the absent or deficient activity of lysosomal hydrolase a‐galactosidase A (α‐Gal A), which leads to the accumulation of its substrates in various organs and tissues. Classic clinical manifestations include angiokeratomas, proteinuria, renal failure, neuropathic pain, and left ventricular hypertrophy. Fever is one of the rare symptoms that may occur during FD. Methods Three Chinese Han patients with FD referred to Peking Union Medical College Hospital were reported. The complete medical records were established, and detailed data were collected. Whole‐exome sequencing by next‐generation sequencing and α‐Gal A enzyme activity assay were performed to confirm the diagnosis. Results These three patients all presented with recurrent fever of unknown origin initially, accompanied with arthralgia/arthritis and other symptoms. We identified two known variants in the GLA gene, c.1176_1179delGAAG and c.782G>A (p.G261D), and a novel variant c.440G>A (p.G147E) which is likely pathogenic in our patient. Conclusions FD should be considered as a rare cause of recurrent fever of unknown origin. The coexistence of gene variants related to systemic autoinflammatory diseases may make the clinical phenotypes of FD more complex and prone to recurrent fever.
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Affiliation(s)
- Yi Luo
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Di Wu
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Min Shen
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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15
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Di Toro A, Narula N, Giuliani L, Concardi M, Smirnova A, Favalli V, Urtis M, Alvisi C, Antoniazzi E, Arbustini E. Pathologic substrate of gastropathy in Anderson-Fabry disease. Orphanet J Rare Dis 2020; 15:156. [PMID: 32571412 PMCID: PMC7310490 DOI: 10.1186/s13023-020-01436-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/09/2020] [Indexed: 11/10/2022] Open
Abstract
In both classic and late-onset AFD, mutations of the GLA gene cause deficient activity of the alpha-galactosidase enzyme resulting in intracellular accumulation of the undigested substrate. Gastrointestinal symptoms (GI) are common but non-specific and imputed to the AFD, irrespective of the demonstration of substrate accumulation in GI cells. We demonstrate substrate accumulation in gastric epithelial, vascular, and nerve cells of patients with classic AFD and, vice versa, absence of accumulation in late-onset AFD and controls.
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Affiliation(s)
- Alessandro Di Toro
- Center for Inherited Cardiovascular Diseases, Transplant Research Area, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy
| | - Nupoor Narula
- Center for Inherited Cardiovascular Diseases, Transplant Research Area, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy.,Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Lorenzo Giuliani
- Center for Inherited Cardiovascular Diseases, Transplant Research Area, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy
| | - Monica Concardi
- Center for Inherited Cardiovascular Diseases, Transplant Research Area, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy
| | - Alexandra Smirnova
- Center for Inherited Cardiovascular Diseases, Transplant Research Area, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy
| | - Valentina Favalli
- Center for Inherited Cardiovascular Diseases, Transplant Research Area, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy.,European Institute of Oncology, Department of Experimental Oncology, Milan, Italy
| | - Mario Urtis
- Center for Inherited Cardiovascular Diseases, Transplant Research Area, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy
| | - Costanza Alvisi
- Internal Medicine - Endoscopy Unit, Ospedale Civile di Voghera, Voghera, ASST, Pavia, Italy
| | - Elena Antoniazzi
- Ophthalmology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Eloisa Arbustini
- Center for Inherited Cardiovascular Diseases, Transplant Research Area, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy.
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16
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Jahan S, Sarathchandran S, Akhter S, Goldblatt J, Stark S, Crawford D, Mallett A, Thomas M. Prevalence of Fabry disease in dialysis patients: Western Australia Fabry disease screening study - the FoRWARD study. Orphanet J Rare Dis 2020; 15:10. [PMID: 31931840 PMCID: PMC6956474 DOI: 10.1186/s13023-019-1290-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 12/24/2019] [Indexed: 11/30/2022] Open
Abstract
Aim To determine the prevalence of undiagnosed Fabry Disease (FD) in Western Australian (WA) patients undergoing dialysis. Background FD is a multisystem X-linked lysosomal storage disease caused by deficient activity of alpha-galactosidase-A (α-GAL-A). Affected individuals are at risk of developing small-fibre neuropathy, rash, progressive kidney disease, hypertrophic cardiomyopathy and ischaemic stroke. Diagnosis is often delayed by years or even decades. Screening high risk population such as dialysis patients may identify patients with undiagnosed Fabry disease. Methods A cross-sectional study was undertaken of all adult patients receiving dialysis in WA, without previously known FD. After informed consent they were screened for α-GAL-A activity by dried blood spot samples. Low or inconclusive activity were repeated via Centogene in Rostock, Germany with GLA genetic analysis. Ethics approval was granted by Royal Perth Hospital Human Research Ethic Committee REG 14–136; site-specific approval was granted from appropriate authorities; ANZ Clinical Trials Registry U1111–1163-7629. Results Between February 2015 & September 2017, α-GAL-A activity was performed on 526 patients at 16 dialysis sites. Twenty-nine patients had initial low α-GAL-A; repeat testing & GLA genotyping showed no confirmed FD cases. The causes of false positive rates were thought to be secondary to impaired protein synthesis due to patient malnutrition and chronic inflammation, which is common among dialysis patients, in addition to poor sampling handling. Conclusion Analysis of this dialysis population has shown a prevalence of 0% undiagnosed FD. False positives results may occur through impaired protein synthesis and sample handling.
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Affiliation(s)
- Sadia Jahan
- Kidney Health Service, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | | | - Shamina Akhter
- Department of Nephrology, Royal Perth Hospital, GPO Box X2213, Perth, WA, 6847, Australia
| | | | - Samantha Stark
- National Referral Laboratory (NRL), Adelaide, SA, Australia
| | - Douglas Crawford
- Department of Nephrology, Royal Perth Hospital, GPO Box X2213, Perth, WA, 6847, Australia
| | - Andrew Mallett
- Kidney Health Service, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Mark Thomas
- Department of Nephrology, Royal Perth Hospital, GPO Box X2213, Perth, WA, 6847, Australia.
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17
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Newborn screening for Fabry disease in the western region of Japan. Mol Genet Metab Rep 2020; 22:100562. [PMID: 31956509 PMCID: PMC6961758 DOI: 10.1016/j.ymgmr.2019.100562] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 12/27/2019] [Accepted: 12/29/2019] [Indexed: 01/02/2023] Open
Abstract
Newborn screening (NBS) for Fabry disease (FD) is the best way to detect FD early prior to presentation of symptoms and is currently implemented in Taiwan and several states such as Illinois, Missouri, and Tennessee in the United States of America. In this report, we provide data from the first large-scale NBS program for FD in Japan. From August 2006 to December 2018, 599,711 newborns were screened; 26 variants, including 15 pathogenic variants and 11 variants of uncertain significance (VOUS; including eight novel variants), were detected in 57 newborns. Twenty-six male and 11 female newborns with pathogenic variants were diagnosed as hemizygous and heterozygous patients, respectively. Thirteen male and seven female newborns with VOUS were diagnosed as potential hemizygous and potential heterozygous patients, respectively. At the most recent follow up, three of 26 hemizygous patients had manifested symptoms and were receiving enzyme replacement therapy. The other patients were being followed up by clinicians. The frequency of FD (pathogenic variants + VOUS) in this study was estimated to be 1:7683, whereas that of patients with pathogenic variants was 1:11,854. In the future, the NBS system for FD may contribute to the detection of newborns not presenting manifestations related to FD and adults who have or have not developed manifestations related to FD.
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18
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Rosa Neto NS, Bento JCDB, Pereira RMR. Higher rate of rheumatic manifestations and delay in diagnosis in Brazilian Fabry disease patients. Adv Rheumatol 2020; 60:7. [PMID: 31907047 DOI: 10.1186/s42358-019-0111-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 12/26/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Fabry disease (FD) is an X-linked lysosomal disorder due to mutations in the GLA gene resulting in defective enzyme alpha-galactosidase A. FD patients are frequently misdiagnosed, commonly for rheumatic diseases. Determining pathogenicity of a mutation depends of in silico predictions but mostly on available clinical information and interpretation may change in light of evolving knowledge. Similar signs and symptoms in carriers of GLA gene genetic variants of unknown significance or of benign variants may hamper diagnosis. This study reviews rheumatic and immune-mediated manifestations in a cohort of Brazilian FD patients with classic mutations and also in subjects with GLA gene A143T and R118C mutations. Misdiagnoses, time to correct diagnosis or determination of GLA gene status, time to treatment initiation and reasons for treatment prescription in A143T and R118C subjects are reviewed. METHODS Genotype confirmed classic FD patients (n = 37) and subjects with GLA gene mutations A143T and R118C (n = 19) were referred for assessment. Subjects with R118C and A143T mutations had been previously identified during screening procedures at hemodialysis units. All patients were interviewed and examined by a rheumatologist with previous knowledge of disease and/or mutation status. A structured tool developed by the authors was used to cover all aspects of FD and of common rheumatic conditions. All available laboratory and imaging data were reviewed. RESULTS Thirty-seven consecutive FD patients were interviewed - 16 male / 21 female (mean age: 43.1 years) and 19 consecutive subjects with GLA gene mutations R118C and A143T were evaluated - 8 male / 11 female (mean age: 39.6 years); 15 [R118C] / 4 [A143T]. Misdiagnosis in FD patients occurred in 11 males (68.8%) and 13 females (61.9%) of which 10 males and 9 females were previously diagnosed with one or more rheumatic conditions, most frequently rheumatic fever or "rheumatism" (unspecified rheumatic disorder). Median time for diagnosis after symptom onset was 16 years (range, 0-52 years). Twenty-two patients were treated with enzyme replacement therapy (ERT) - 13 male and 9 female. Median time to ERT initiation after FD diagnosis was 0.5 years (range, 0-15 years). Rheumatic manifestations occurred in 68.4% of R118C and A143T subjects. Two subjects had been prescribed ERT because of renal disease [R118C] and neuropsychiatric symptoms [A143T]. CONCLUSION Misdiagnoses occurred in 64.8% of FD patients, most frequently for rheumatic conditions. Median time for correct diagnosis was 16 years. Rheumatic manifestations are also frequent in subjects with GLA gene R118C and A143T mutations. These results reinforce the need to raise awareness and increase knowledge about Fabry disease among physicians, notably rheumatologists, who definitely have a role in identifying patients and determining disease burden. Decision to start treatment should consider expert opinion and follow local guidelines.
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Affiliation(s)
- Nilton Salles Rosa Neto
- Rheumatology Division, Faculdade de Medicina da Universidade de São, Paulo, São Paulo, Brazil.
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19
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Zhou C, Huang J, Cui G, Zeng H, Wang DW, Zhou Q. Identification of a novel loss-of-function mutation of the GLA gene in a Chinese Han family with Fabry disease. BMC MEDICAL GENETICS 2018; 19:219. [PMID: 30587147 PMCID: PMC6307325 DOI: 10.1186/s12881-018-0734-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 12/13/2018] [Indexed: 11/11/2022]
Abstract
Background Fabry disease is an X-linked recessive lysosomal disorder caused by deficient enzymatic activity of α-galactosidase A (α-Gal A). The insufficient enzymatic activity leads to excessive accumulation of glycosphingolipids, the substrates of the enzyme, in lysosomes in organs and tissues. Mutations in the α-Gal A gene (GLA, Xq22) have been proven to be responsible for Fabry disease. Methods In this study, we report a four-generation pedigree with left ventricular hypertrophy and chronic renal failure that was diagnosed by sequencing the GLA gene. An over expression system was constructed to evaluate the function of the detected mutation. Results We identified a novel mutation in exon 6 of the GLA gene, p.Asn278Lys, which completely co-segregated with the disease phenotype. The protein level of α-Gal A was significantly lower in the variant group than in the wild-type group; additionally, the pharmacological chaperone 1-deoxy-galactonojirimycin (DGJ) effectively normalized the enzyme activity of α-Gal A and its decline at the protein level. Conclusions This study is the first to report a novel loss-of-function mutation, p.Asn278Lys, in exon 6 of the GLA gene as a genetic aetiology for Fabry disease. In addition, we analysed the feasibility of DGJ as a therapeutic approach for this particular GLA mutation.
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Affiliation(s)
- Chi Zhou
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, China
| | - Jin Huang
- Division of Hematology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Guanglin Cui
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, China.
| | - Hesong Zeng
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, China
| | - Qiang Zhou
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, China.
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20
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Mutations in the GLA Gene and LysoGb3: Is It Really Anderson-Fabry Disease? Int J Mol Sci 2018; 19:ijms19123726. [PMID: 30477121 PMCID: PMC6320967 DOI: 10.3390/ijms19123726] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 11/15/2018] [Accepted: 11/18/2018] [Indexed: 01/01/2023] Open
Abstract
Anderson-Fabry disease (FD) is a rare, progressive, multisystem storage disorder caused by the partial or total deficit of the lysosomal enzyme α-galactosidase A (α-Gal A). It is an X-linked, lysosomal enzymopathy due to mutations in the galactosidase alpha gene (GLA), encoding the α-Gal A. To date, more than 900 mutations in this gene have been described. In our laboratories, the study of genetic and enzymatic alterations related to FD was performed in about 17,000 subjects with a symptomatology referable to this disorder. The accumulation of globotriaosylsphingosine (LysoGb3) was determined in blood of positives. Exonic mutations in the GLA gene were detected in 471 patients (207 Probands and 264 relatives): 71.6% of mutations were associated with the classic phenotype, 19.8% were associated with the late-onset phenotype, and 8.6% of genetic variants were of unknown significance (GVUS). The accumulation of LysoGb3 was found in all male patients with a mutation responsible for classic or late-onset FD. LysoGb3 levels were consistent with the type of mutations and the symptomatology of patients. α-Gal A activity in these patients is absent or dramatically reduced. In recent years, confusion about the pathogenicity of some mutations led to an association between non-causative mutations and FD. Our study shows that the identification of FD patients is possible by associating clinical history, GLA gene analysis, α-Gal A assay, and blood accumulation of LysoGB3. In our experience, LysoGB3 can be considered a reliable marker, which is very useful to confirm the diagnosis of Fabry disease.
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21
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Ravarotto V, Carraro G, Pagnin E, Bertoldi G, Simioni F, Maiolino G, Martinato M, Landini L, Davis PA, Calò LA. Oxidative stress and the altered reaction to it in Fabry disease: A possible target for cardiovascular-renal remodeling? PLoS One 2018; 13:e0204618. [PMID: 30261035 PMCID: PMC6160124 DOI: 10.1371/journal.pone.0204618] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/11/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Fabry disease is characterized by deficient expression/activity of α-GalA with consequent lysosomal accumulation in various organs of its substrate Gb3. Despite enzyme replacement therapy, Fabry disease progresses with serious myocardial, cerebral and renal manifestations. Gb3 accumulation may induce oxidative stress (OxSt), production of inflammatory cytokines and reduction of nitric oxide, which may impact on Fabry disease's clinical manifestations. METHODS OxSt status was characterized in 10 patients compared with 10 healthy subjects via protein expression of p22phox, subunit of NADH/NADPH oxidase, (Western blot), Heme oxygenase (HO)-1 levels (ELISA), antioxidant/anti-inflammatory, lipid peroxidation as malondialdehyde (MDA) production (colorimetric assay), phosphorylation state of Extracellular Signal Regulated Kinase (ERK)1/2 and Myosin Phosphatase Target Protein (MYPT)-1 (Western blot), marker of Rho kinase activation, both involved in OxSt signaling. Cardiac left ventricular (LV) mass was also evaluated (M-mode echocardiography). RESULTS LV mass was higher in Fabry's males (123.72±2.03SEM g/m2) and females (132.09±6.72g/m2). p22phox expression was also higher in patients (1.04±0.09 d.u. vs 0.54±0.05 d.u. p<0.01) as well as MDA levels (54.51±3.97 vs 30.05±7.11 nmol/mL p = 0.01) while HO-1 was reduced (8.84±0.79 vs 14.03±1.23 ng/mL, p<0.02). MYPT-1's phosphorylation was increased in patients (0.52±0.11 d.u. vs 0.03±0.08 d.u., p<0.01) while phosphorylation of ERK1/2 was reduced (0.91±0.08 d.u. vs 1.53±0.17 d.u., p = 0.004). CONCLUSIONS This study documents OxSt activation and the altered reaction to it in Fabry patients. Cardiac remodeling, Rho kinase signaling activation and reduction of protective HO-1 might suggest that, in addition to enzyme replacement therapy, OxSt inhibition by either pharmacological or nutritional measures, is likely to prove useful for the prevention/treatment of Fabry patients' cardiovascular-renal remodeling.
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Affiliation(s)
| | - Gianni Carraro
- Department of Medicine, Nephrology, University of Padua, Padua Italy
| | - Elisa Pagnin
- Department of Medicine, Nephrology, University of Padua, Padua Italy
| | - Giovanni Bertoldi
- Department of Medicine, Nephrology, University of Padua, Padua Italy
| | - Francesca Simioni
- Department of Medicine, Nephrology, University of Padua, Padua Italy
| | - Giuseppe Maiolino
- Department of Medicine, Hypertension, University of Padua, Padua Italy
| | | | | | - Paul A Davis
- Department of Nutrition, University of California, Davis, United States of America
| | - Lorenzo A Calò
- Department of Medicine, Nephrology, University of Padua, Padua Italy
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Liern M, Collazo A, Valencia M, Fainboin A, Isse L, Costales-Collaguazo C, Ochoa F, Vallejo G, Zotta E. Podocyturia in paediatric patients with Fabry disease. Nefrologia 2018; 39:177-183. [PMID: 30139698 DOI: 10.1016/j.nefro.2018.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/11/2018] [Accepted: 05/14/2018] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Fabry disease (FD) is a hereditary disorder caused by a deficiency of α-galactosidase A enzyme activity. The transmission of the disorder is linked to the X chromosome. OBJECTIVES The objectives of the study were: 1. To quantify the presence of podocytes in paediatric patients with FD and compare them with the value of the measured podocyturia in healthy controls. 2. To determine whether a greater podocyturia is related to the onset of pathological albuminuria in patients with FD. 3. To determine the risk factors associated with pathological albuminuria. METHODS We performed an analytical, observational study of Fabry and control subjects, which were separated into 2groups in accordance with the absence of the disease (control group) or the presence of the disease (Fabry group). RESULTS We studied 31 patients, 11 with FD and 20 controls, with a mean age of 11.6 years. The difference between the mean time elapsed from the diagnosis of FD to the measurement of podocyturia (40 months) and the onset of pathological albuminuria (34 months) was not significant (p=0.09). Podocytes were identified by staining for the presence of synaptopodin and the mean quantitative differences between both podocyturias were statistically significant (p=0.001). Albuminuria was physiological in 4 of the patients with FD and the relative risk to develop pathological albuminuria according to podocyturia was 1.1 in the control group and 3.9 in the Fabry group, with a coefficient of correlation between podocyturia and albuminuria in the Fabry group of 0.8354. Finally, the 2 risk factors associated with the development of pathological albuminuria were podocyturia (OR: 14) and being aged over 10 years (OR: 18). We found no significant risk with regard to glomerular filtrate renal (GFR) (OR: 0.5) or gender (OR: 1.3). The mean GFR remained within normal values. CONCLUSION The detection of podocyturia in paediatric patients with FD could be used as an early marker of renal damage, preceding and proportional to the occurrence of pathological albuminuria.
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Affiliation(s)
- Miguel Liern
- Unidad de Nefrología, Hospital General de Niños Ricardo Gutiérrez, Buenos Aires, Argentina.
| | - Anabella Collazo
- Unidad de Nefrología, Hospital General de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Maylin Valencia
- Unidad de Nefrología, Hospital General de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Alejandro Fainboin
- Unidad de Nefrología, Hospital General de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Lorena Isse
- Unidad de Nefrología, Hospital General de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Cristian Costales-Collaguazo
- Departamento de Ciencias Fisiológicas IFIBIO Houssay, CONICET, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina; Cátedra de Fisiopatología, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Federico Ochoa
- Departamento de Ciencias Fisiológicas IFIBIO Houssay, CONICET, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Graciela Vallejo
- Unidad de Nefrología, Hospital General de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Elsa Zotta
- Departamento de Ciencias Fisiológicas IFIBIO Houssay, CONICET, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina; Cátedra de Fisiopatología, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
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Trapani S, Montemaggi A, Dini E, Pozzessere A, Donati MA, Resti M. Recurrent Burning Limb Pain Diagnosed as Psychiatric Disorder in Adolescence: A Case of True Neuro-Metabolic Disease. PAIN MEDICINE 2018; 19:1696-1697. [PMID: 29301004 DOI: 10.1093/pm/pnx323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sandra Trapani
- Pediatric Unit, Department of Sciences of Health, Anna Meyer Children's Hospital, Florence, Italy
| | - Alessandra Montemaggi
- Pediatric Unit, Department of Sciences of Health, Anna Meyer Children's Hospital, Florence, Italy
| | - Eleonora Dini
- Pediatric Unit, Department of Sciences of Health, Anna Meyer Children's Hospital, Florence, Italy
| | - Anna Pozzessere
- Pediatric Unit, Department of Sciences of Health, Anna Meyer Children's Hospital, Florence, Italy
| | - Maria Alice Donati
- Neuro-Metabolic Unit, Department of Neurosciences Pharmacology and Child Health, Anna Meyer Children's Hospital, Florence, Italy
| | - Massimo Resti
- Pediatric Unit, Department of Sciences of Health, Anna Meyer Children's Hospital, Florence, Italy
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Hilz MJ, Arbustini E, Dagna L, Gasbarrini A, Goizet C, Lacombe D, Liguori R, Manna R, Politei J, Spada M, Burlina A. Non-specific gastrointestinal features: Could it be Fabry disease? Dig Liver Dis 2018; 50:429-437. [PMID: 29602572 DOI: 10.1016/j.dld.2018.02.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/19/2018] [Accepted: 02/19/2018] [Indexed: 12/11/2022]
Abstract
Non-specific gastrointestinal symptoms, including pain, diarrhoea, nausea, and vomiting, can be the first symptoms of Fabry disease. They may suggest more common disorders, e.g. irritable bowel syndrome or inflammatory bowel disease. The confounding clinical presentation and rarity of Fabry disease often cause long diagnostic delays and multiple misdiagnoses. Therefore, specialists involved in the clinical evaluation of non-specific upper and lower gastrointestinal symptoms should recognize Fabry disease as a possible cause of the symptoms, and should consider Fabry disease as a possible differential diagnosis. When symptoms or family history suggest Fabry disease, in men, low alpha-galactosidase A enzyme levels, and in women, specific Fabry mutations confirm the diagnosis. In addition to symptomatic treatments, disease-specific enzyme replacement therapy with recombinant human alpha-galactosidase A enzyme or chaperone therapy (migalastat) in patients with amenable mutations can improve the disease, including gastrointestinal symptoms, and should be initiated as early as possible after Fabry disease has been confirmed; starting enzyme replacement therapy at as young an age as possible after diagnosis improves long-term clinical outcomes. Improved diagnostic tools, such as a modified gastrointestinal symptom rating scale, may facilitate diagnosing Fabry disease in patients with gastrointestinal symptoms of unknown cause and thus assure timely initiation of disease-specific treatment.
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Affiliation(s)
- Max J Hilz
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Eloisa Arbustini
- Center for Inherited Cardiovascular Diseases, IRCCS Foundation Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Gasbarrini
- Department of Medical Sciences, Division of Gastroenterology, Catholic University, Rome, Italy
| | - Cyril Goizet
- CHU Bordeaux, Department of Medical Genetics, Bordeaux, France; INSERM Unit 1211, Laboratoire MRGM, University of Bordeaux, Bordeaux, France
| | - Didier Lacombe
- CHU Bordeaux, Department of Medical Genetics, Bordeaux, France; INSERM Unit 1211, Laboratoire MRGM, University of Bordeaux, Bordeaux, France
| | - Rocco Liguori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Raffaele Manna
- Periodic Fever and Rare Diseases Research Centre, Gemelli Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Juan Politei
- Department of Neurology, Fundación para el Estudio de las Enfermedades Neurometabólicas (FESEN), Buenos Aires, Argentina
| | - Marco Spada
- Department of Pediatrics, University of Torino, Torino, Italy
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25
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Fabry disease and multiple sclerosis misdiagnosis: the role of family history and neurological signs. Oncotarget 2018; 9:7758-7762. [PMID: 29487688 PMCID: PMC5814255 DOI: 10.18632/oncotarget.23970] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 12/27/2017] [Indexed: 01/04/2023] Open
Abstract
Fabry disease (FD) is an X-linked inherited lysosomal storage disorder caused by α galactosidase A (α-gal A) deficiency. Central nervous system involvement and chronic white matter lesions are observed in both FD and multiple sclerosis (MS), which can confound the differential diagnosis. We analyzed the GLA gene, which encodes α-gal A, in 86 patients with clinical and neuroradiological findings consistent with MS to determine whether they had FD. We identified four women initially diagnosed with MS who had GLA mutations associated with FD. Our results indicate that family history besides neurological findings should be evaluated in patients with an uncertain diagnosis of MS. Also the involvement of organs outside the central nervous system can support the FD diagnosis.
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Manna R, Cauda R, Feriozzi S, Gambaro G, Gasbarrini A, Lacombe D, Livneh A, Martini A, Ozdogan H, Pisani A, Riccio E, Verrecchia E, Dagna L. Recommendations for the inclusion of Fabry disease as a rare febrile condition in existing algorithms for fever of unknown origin. Intern Emerg Med 2017; 12:1059-1067. [PMID: 28726033 DOI: 10.1007/s11739-017-1704-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 06/27/2017] [Indexed: 12/26/2022]
Abstract
Fever of unknown origin (FUO) is a rather rare clinical syndrome representing a major diagnostic challenge. The occurrence of more than three febrile attacks with fever-free intervals of variable duration during 6 months of observation has recently been proposed as a subcategory of FUO, Recurrent FUO (RFUO). A substantial number of patients with RFUO have auto-inflammatory genetic fevers, but many patients remain undiagnosed. We hypothesize that this undiagnosed subgroup may be comprised of, at least in part, a number of rare genetic febrile diseases such as Fabry disease. We aimed to identify key features or potential diagnostic clues for Fabry disease as a model of rare genetic febrile diseases causing RFUO, and to develop diagnostic guidelines for RFUO, using Fabry disease as an example of inserting other rare diseases in the existing FUO algorithms. An international panel of specialists in recurrent fevers and rare diseases, including internists, infectious disease specialists, rheumatologists, gastroenterologists, nephrologists, and medical geneticists convened to review the existing diagnostic algorithms, and to suggest recommendations for arriving at accurate diagnoses on the basis of available literature and clinical experience. By combining specific features of rare diseases with other diagnostic considerations, guidelines have been designed to raise awareness and identify rare diseases among other causes of FUO. The proposed guidelines may be useful for the inclusion of rare diseases in the diagnostic algorithms for FUO. A wide spectrum of patients will be needed to validate the algorithm in different clinical settings.
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Affiliation(s)
- Raffaele Manna
- Centro di Ricerca delle Febbri Periodiche e Malattie Rare, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Roberto Cauda
- Istituto di Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Giovanni Gambaro
- Divisione di Nefrologia, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Gasbarrini
- Divisione di Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Didier Lacombe
- CHU Bordeaux, MRGM Laboratory, Department Medical Genetics, University of Bordeaux, Bordeaux, France
| | - Avi Livneh
- Department of Medicine, Sheba Medical Center, Tel Hashomer, Israel, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Huri Ozdogan
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University Fatih, Istanbul, Turkey
| | | | | | - Elena Verrecchia
- Centro di Ricerca delle Febbri Periodiche e Malattie Rare, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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Godel T, Bäumer P, Pham M, Köhn A, Muschol N, Kronlage M, Kollmer J, Heiland S, Bendszus M, Mautner VF. Human dorsal root ganglion in vivo morphometry and perfusion in Fabry painful neuropathy. Neurology 2017; 89:1274-1282. [DOI: 10.1212/wnl.0000000000004396] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 06/30/2017] [Indexed: 11/15/2022] Open
Abstract
Objective:To evaluate functional and morphometric magnetic resonance neurography of the dorsal root ganglion and peripheral nerve segments in patients with Fabry painful neuropathy.Methods:In this prospective study, the lumbosacral dorsal root ganglia and proximal peripheral nerve segments of the lower extremity were examined in 11 male patients with Fabry disease by a standardized 3T magnetic resonance neurography protocol. Volumes of L3 to S2 dorsal root ganglia, perfusion parameters of L5-S1 dorsal root ganglia and the spinal nerve L5, and the cross-sectional area of the proximal sciatic nerve were compared to healthy controls.Results:Dorsal root ganglia of patients with Fabry disease were symmetrically enlarged by 78% (L3), 94% (L4), 122% (L5), 115% (S1), and 119% (S2) (p < 0.001). In addition, permeability of the blood-tissue interface was decreased by 53% (p < 0.001). This finding was most pronounced in the peripheral zone of the dorsal root ganglion containing the cell bodies of the primary sensory neurons (p < 0.001). Spinal nerve permeability showed no difference between patients with Fabry disease and controls (p = 0.7). The sciatic nerve of patients with Fabry disease at the thigh level showed an increase in cross-sectional area by 48% (p < 0.001).Conclusions:Patients with Fabry disease have severely enlarged dorsal root ganglia with dysfunctional perfusion. This may be due to glycolipid accumulation in the dorsal root ganglia mediating direct neurotoxic effects and decreased neuronal blood supply. These alterations were less pronounced in peripheral nerve segments. Thus, the dorsal root ganglion might play a key pathophysiologic role in the development of neuropathy and pain in Fabry disease.
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Carmona S, Weinschelbaum R, Pardal A, Marchesoni C, Zuberbuhler P, Acosta P, Cáceres G, Kisinovsky I, Bayón L, Reisin R. Neuro-Otological and Peripheral Nerve Involvement in Fabry Disease. Audiol Res 2017; 7:176. [PMID: 28794847 PMCID: PMC5534773 DOI: 10.4081/audiores.2017.176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 06/19/2017] [Accepted: 06/19/2017] [Indexed: 12/17/2022] Open
Abstract
Fabry disease (FD) is an X-linked lysosomal storage disease, with multisystemic glycosphingolipids deposits. Neuro-otological involvement leading to hearing loss and vestibular dysfunctions has been described, but there is limited information about the frequency, site of lesion, or the relationship with peripheral neuropathy. The aim was to evaluate the presence of auditory and vestibular symptoms, and assess neurophysiological involvement of the VIII cranial nerve, correlating these findings with clinical and neurophysiological features of peripheral neuropathy. We studied 36 patients with FD with a complete neurological and neuro-otological evaluation including nerve conduction studies, quantitative sensory testing (to evaluate small fiber by warm and cold threshold detection and cold and heat pain), vestibular evoked myogenic potentials, videonistagmography, audiometry and brainstem auditory evoked potentials. Neuro-otologic symptoms included hearing loss (22.2%), vertigo (27.8%) or both (25%). An involvement of either cochlear or vestibular function was identified in most patients (75%). In 70% of our patients the involvement of both cochlear and vestibular function could not be explained by a neural or vascular mechanism. Small fiber neuropathy was identified in 77.7%. There were no significant associations between neuro-otological and QST abnormalities. Neuro-otologic involvement is frequent and most likely under-recognized in patients with FD. It lacks a specific neural or vascular pattern, suggesting multi-systemic, end organ damage. Small fiber neuropathy is an earlier manifestation of FD, but there is no correlation between the development of neuropathy and neuro-otological abnormalities.
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Affiliation(s)
- Sergio Carmona
- Department of Neuro-otology INEBA, British Hospital, Buenos Aires, Argentina
| | | | - Ana Pardal
- Department of Neurology, British Hospital, Buenos Aires, Argentina
| | | | - Paz Zuberbuhler
- Department of Neurology, British Hospital, Buenos Aires, Argentina
| | - Patricia Acosta
- Department of Neurology, British Hospital, Buenos Aires, Argentina
| | | | | | - Luciana Bayón
- Department of Neuro-otology INEBA, British Hospital, Buenos Aires, Argentina
| | - Ricardo Reisin
- Department of Neurology, British Hospital, Buenos Aires, Argentina
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Consenso del Grupo Centroamericano y del Caribe para el Estudio y Tratamiento de la Enfermedad de Fabry. NEFROLOGÍA LATINOAMERICANA 2017. [DOI: 10.1016/j.nefrol.2016.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Beirão I, Cabrita A, Torres M, Silva F, Aguiar P, Gomes AM. Anderson-Fabry Disease. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2016. [DOI: 10.1177/2326409816669372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Idalina Beirão
- Centro Hospitalar do Porto, Largo Professor Abel Salazar, Porto, Portugal
| | - Ana Cabrita
- Service of Centro Hospitalar do Algarve, Rua Leao Penedo, Faro, Portugal
| | - Márcia Torres
- Centro Hospitalar do Médio Ave, Largo Domingos Moreira, Santo Tirso, Portugal
| | - Fernando Silva
- Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Patricio Aguiar
- Hospital de Santa Maria/Centro Hospitalar Lisboa Norte, Avenida Professor Egas Moniz, Lisboa, Portugal
| | - Ana Marta Gomes
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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31
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Politei JM, Durand C, Schenone AB. Small Fiber Neuropathy in Fabry Disease: a Review of Pathophysiology and Treatment. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2016. [DOI: 10.1177/2326409816661351] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Juan M. Politei
- Laboratorio Neuroquímica, Dr Nestor Chamoles, Fundación para el estudio de las enfermedades neurometabólicas (FESEN), Buenos Aires, Argentina
| | - Consuelo Durand
- Laboratorio Neuroquímica, Dr Nestor Chamoles, Fundación para el estudio de las enfermedades neurometabólicas (FESEN), Buenos Aires, Argentina
| | - Andrea B. Schenone
- Laboratorio Neuroquímica, Dr Nestor Chamoles, Fundación para el estudio de las enfermedades neurometabólicas (FESEN), Buenos Aires, Argentina
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Ito S, Ogura M, Kamei K, Matsuoka K, Warnock DG. Significant improvement in Fabry disease podocytopathy after 3 years of treatment with agalsidase beta. Pediatr Nephrol 2016; 31:1369-73. [PMID: 27129690 DOI: 10.1007/s00467-016-3387-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Fabry disease is an X-linked lysosomal disorder caused by decreased activity of α-galactosidase A (GLA). Consequent accumulation of globotriaosylceramide (GL-3) in lysosomes results in damage to a variety of organs, including the kidneys. Enzyme replacement therapy (ERT) is an effective treatment, but whether it should be started before organ damage is evident is a matter of debate. CASE DIAGNOSIS/TREATMENT A 10-year-old boy who complained of severe sole pain for 3 years had been misdiagnosed with juvenile idiopathic arthritis. Further investigations revealed decreased GLA activity and a M1T mutation in the GLA gene causing protein truncation, suggestive of Fabry disease. Despite normal renal function and urinalysis, renal biopsy showed abnormal structure, with marked accumulation of GL-3 in podocytes, partial effacement of foot processes and irregularly reduced expression of nephrin in the slit diaphragm. After 1 year of ERT with 1 mg/kg agalsidase beta once every 2 weeks, his pain had resolved with ERT combined with carbamazepine and pregabalin. After 3 years of the ERT, repeat biopsy showed little renal GL-3 deposition, resolution of foot process effacement, and a dramatic improvement in nephrin expression. CONCLUSIONS There may be a window of opportunity in which pain and renal injury can be addressed in the early stages of Fabry disease. Early initiation of ERT should therefore be considered for children with Fabry disease.
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Affiliation(s)
- Shuichi Ito
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, 3-9 Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan. .,Division of Pediatric Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan.
| | - Masao Ogura
- Division of Pediatric Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Koichi Kamei
- Division of Pediatric Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Kentaro Matsuoka
- Division of Pathology, National Center for Child Health and Development, Tokyo, Japan
| | - David G Warnock
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Verrecchia E, Zampetti A, Antuzzi D, Ricci R, Ferri L, Morrone A, Feliciani C, Dagna L, Manna R. The impact of fever/hyperthermia in the diagnosis of Fabry: A retrospective analysis. Eur J Intern Med 2016; 32:26-30. [PMID: 27083555 DOI: 10.1016/j.ejim.2016.03.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 03/09/2016] [Accepted: 03/18/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Fabry disease (FD) is an X-linked lysosomal storage disorder caused by a deficiency of alpha-galactosidase A enzyme, which leads to the accumulation of its substrate, the globotriaosylceramide or Gb3, in many organs and tissues. Main clinical manifestations of FD are neuropathic pain, angiokeratomas, proteinuria and renal failure, left ventricular hypertrophy and stroke. Fever is also a possible symptom at the onset of the disease during childhood and adolescence, but it is frequently misdiagnosed, causing a delay in FD diagnosis. METHODS We retrospectively analysed the medical records in our series of 58 Fabry patients, focusing on the proportion of patients who exhibited fever as the main symptom at the onset of FD in order to evaluate the diagnostic delay in these patients. FINDINGS In our series, we found a significant proportion of patients with a history of fevers at the beginning of their medical history (20.7%; 12/58). 83% of patients with fever also exhibited acroparesthesias (10/12). Inflammatory markers were elevated in few of those cases (2/12). The mean diagnostic delay was 15.6±SD 12.8years. INTERPRETATION Fever emerged to be common as part of the FD clinical spectrum and it significantly contributed to the diagnostic delay encountered with this rare disease. Furthermore, our retrospective analysis indicated that FD patients commonly exhibit episodes of fever in association with other symptoms suggestive of FD (such as episodic pain crisis, acroparesthesias, hypo/anhydrosis, heat intolerance, fatigue and gastrointestinal distress). A careful analysis of the medical history in patients suffering fever could lead to an early and correct FD diagnosis. We believe that fever/hyperthermia, acroparesthesias and angiokeratoma should be considered for inclusion in the algorithm for Intermittent Fever of Unknown Origin (FUO) in order to improve the recognition of FD.
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Affiliation(s)
- Elena Verrecchia
- Periodic Fever Research Centre, A. Gemelli Policlinic, Catholic University of the Sacred Heart, Rome, Italy
| | - Anna Zampetti
- Department of Dermatology Saint Mary's Hospital, Imperial College NHS Trust, London, UK
| | - Daniela Antuzzi
- Department of Paediatric Sciences, A. Gemelli Policlinic, Rome, Italy
| | - Roberta Ricci
- Department of Paediatric Sciences, A. Gemelli Policlinic, Rome, Italy
| | - Lorenzo Ferri
- Laboratory for Molecular and Cell Biology of Neurologic and Metabolic Disorders, Paediatric Neurology Unit and Laboratories, Meyer Children's Hospital, Florence, Italy; Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Amelia Morrone
- Laboratory for Molecular and Cell Biology of Neurologic and Metabolic Disorders, Paediatric Neurology Unit and Laboratories, Meyer Children's Hospital, Florence, Italy; Department of NEUROFARBA, University of Florence, Florence, Italy
| | | | - Lorenzo Dagna
- Vita-Salute San Raffaele University, Milan, Italy; Unit of Medicine and Clinical Immunology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaele Manna
- Periodic Fever Research Centre, A. Gemelli Policlinic, Catholic University of the Sacred Heart, Rome, Italy.
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Zar-Kessler C, Karaa A, Sims KB, Clarke V, Kuo B. Understanding the gastrointestinal manifestations of Fabry disease: promoting prompt diagnosis. Therap Adv Gastroenterol 2016; 9:626-34. [PMID: 27366228 PMCID: PMC4913334 DOI: 10.1177/1756283x16642936] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Fabry disease is a rare X-linked lysosomal storage disease characterized by the dysfunction of multiple systems, including significant gastrointestinal involvement such as diarrhea, abdominal pain, early satiety and nausea. The gastrointestinal symptoms of Fabry disease are thought to be due to neuropathic and myopathic changes leading to symptoms of dysmotility that are encountered in many other disorders. The gastrointestinal symptoms can often be one of the presenting signs of the disease in childhood, but can be misdiagnosed by gastroenterologists for many years due to their nonspecific presentation. As the chief treatment for Fabry is enzyme-replacement therapy that has been shown to stabilize and possibly reverse disease course, recognition of these symptoms and early diagnosis in an attempt to prevent progression with treatment, is critical.
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Affiliation(s)
| | - Amel Karaa
- Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
| | | | - Virginia Clarke
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Braden Kuo
- MGH Center for Neurointestinal Health, GI Unit Massachusetts General Hospital, Boston, MA, USA
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Politei J, Thurberg B, Wallace E, Warnock D, Serebrinsky G, Durand C, Schenone A. Gastrointestinal involvement in Fabry disease. So important, yet often neglected. Clin Genet 2015; 89:5-9. [DOI: 10.1111/cge.12673] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 08/23/2015] [Accepted: 08/31/2015] [Indexed: 12/22/2022]
Affiliation(s)
- J. Politei
- Department of Neurology; Fundación para el Estudio de las Enfermedades Neurometabólicas (FESEN); Buenos Aires Argentina
| | - B.L. Thurberg
- Department of Pathology; Genzyme Corporation; Framingham MA USA
| | - E. Wallace
- Department of Medicine; University of Alabama; Birmingham AL USA
| | - D. Warnock
- Department of Medicine; University of Alabama; Birmingham AL USA
| | | | - C. Durand
- Department of Neurology; Fundación para el Estudio de las Enfermedades Neurometabólicas (FESEN); Buenos Aires Argentina
| | - A.B. Schenone
- Department of Neurology; Fundación para el Estudio de las Enfermedades Neurometabólicas (FESEN); Buenos Aires Argentina
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36
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37
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Brady M, Montgomery E, Brennan P, Mohindra R, Sayer JA. Diagnosing Fabry disease--delays and difficulties within discordant siblings. QJM 2015; 108:585-90. [PMID: 23378663 DOI: 10.1093/qjmed/hct024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Brady
- From the Renal Services Centre, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK, James Cook University Hospital, Middlesbrough, TS4 3BW, UK, Institute of Genetic Medicine, Newcastle University, Central Parkway, Newcastle NE1 3BZ, UK and Cardiology Department, South Tyneside District Hospital, Tyne & Wear, NE34 0PL, UK
| | - E Montgomery
- From the Renal Services Centre, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK, James Cook University Hospital, Middlesbrough, TS4 3BW, UK, Institute of Genetic Medicine, Newcastle University, Central Parkway, Newcastle NE1 3BZ, UK and Cardiology Department, South Tyneside District Hospital, Tyne & Wear, NE34 0PL, UK
| | - P Brennan
- From the Renal Services Centre, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK, James Cook University Hospital, Middlesbrough, TS4 3BW, UK, Institute of Genetic Medicine, Newcastle University, Central Parkway, Newcastle NE1 3BZ, UK and Cardiology Department, South Tyneside District Hospital, Tyne & Wear, NE34 0PL, UK From the Renal Services Centre, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK, James Cook University Hospital, Middlesbrough, TS4 3BW, UK, Institute of Genetic Medicine, Newcastle University, Central Parkway, Newcastle NE1 3BZ, UK and Cardiology Department, South Tyneside District Hospital, Tyne & Wear, NE34 0PL, UK
| | - R Mohindra
- From the Renal Services Centre, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK, James Cook University Hospital, Middlesbrough, TS4 3BW, UK, Institute of Genetic Medicine, Newcastle University, Central Parkway, Newcastle NE1 3BZ, UK and Cardiology Department, South Tyneside District Hospital, Tyne & Wear, NE34 0PL, UK
| | - J A Sayer
- From the Renal Services Centre, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK, James Cook University Hospital, Middlesbrough, TS4 3BW, UK, Institute of Genetic Medicine, Newcastle University, Central Parkway, Newcastle NE1 3BZ, UK and Cardiology Department, South Tyneside District Hospital, Tyne & Wear, NE34 0PL, UK From the Renal Services Centre, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK, James Cook University Hospital, Middlesbrough, TS4 3BW, UK, Institute of Genetic Medicine, Newcastle University, Central Parkway, Newcastle NE1 3BZ, UK and Cardiology Department, South Tyneside District Hospital, Tyne & Wear, NE34 0PL, UK
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High variability of Fabry disease manifestations in an extended Italian family. BIOMED RESEARCH INTERNATIONAL 2015; 2015:504784. [PMID: 25977923 PMCID: PMC4421032 DOI: 10.1155/2015/504784] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/11/2015] [Accepted: 03/24/2015] [Indexed: 12/22/2022]
Abstract
Fabry disease (FD) is an inherited metabolic disorder caused by partial or full inactivation of the lysosomal hydrolase α-galactosidase A (α-GAL). The impairment of α-GAL results in the accumulation of undegraded glycosphingolipids in lysosomes and subsequent cell and microvascular dysfunctions. This study reports the clinical, biochemical, and molecular characterization of 15 members of the same family. Eight members showed the exonic mutation M51I in the GLA gene, a disease-causing mutation associated with the atypical phenotype. The clinical history of this family highlights a wide phenotypic variability, in terms of involved organs and severity. The phenotypic variability of two male patients is not related to differences in α-GAL enzymatic activity: though both have no enzymatic activity, the youngest shows severe symptoms, while the eldest is asymptomatic. It is noticeable that for two female patients with the M51I mutation the initial clinical diagnosis was different from FD. One of them was diagnosed with Familial Mediterranean Fever, the other with Multiple Sclerosis. Overall, this study confirms that the extreme variability of the clinical manifestations of FD is not entirely attributable to different mutations in the GLA gene and emphasizes the need to consider other factors or mechanisms involved in the pathogenesis of Fabry Disease.
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Ellaway C. Diagnostic dilemma and delay in Fabry disease: insights from a case series of young female patients. J Paediatr Child Health 2015; 51:369-72. [PMID: 25195704 DOI: 10.1111/jpc.12732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Carolyn Ellaway
- Western Sydney Genetics Program, Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Biegstraaten M, Linthorst GE, van Schaik IN, Hollak CEM. Fabry disease: a rare cause of neuropathic pain. Curr Pain Headache Rep 2014; 17:365. [PMID: 23996721 DOI: 10.1007/s11916-013-0365-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Fabry disease is characterized by burning or shooting pains in hands and feet, which have a severe impact on the quality of life of patients. It is therefore of importance that Fabry patients receive adequate diagnosis, counseling, treatment and follow up. This review describes neuropathic pain in classical Fabry disease with the aim to help clinicians to recognize Fabry patients among patients presenting with chronic extremity pain. The diagnostic dilemmas in patients with neuropathic pain and a non-classical disease course are discussed, together with the available diagnostic modalities, pain medication options and the effect of enzyme replacement therapy on small fiber neuropathy.
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Affiliation(s)
- Marieke Biegstraaten
- Department of Internal Medicine, div Endocrinology and Metabolism, Academic Medical Center, Amsterdam, The Netherlands.
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Thomas AS, Mehta AB. Difficulties and barriers in diagnosing Fabry disease: what can be learnt from the literature? ACTA ACUST UNITED AC 2013; 7:589-99. [PMID: 24128193 DOI: 10.1517/17530059.2013.846322] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Fabry disease (FD) is an X-linked disorder of glycosphingolipid metabolism caused by deficiency of the lysosomal enzyme alpha galactosidase A. Clinical features include neuropathic pain, rash, proteinuria renal failure, stroke and cardiomyopathy accompanied by a reduced life expectancy. Patients report an average delay of > 10 years between symptom onset and diagnosis. Newborn screening studies suggest a much higher prevalence than that found on population studies supporting the notion that FD is under-diagnosed. AREAS COVERED Four key challenges in the diagnosis of FD and strategies to overcome them are discussed. The clinical features of FD are highly heterogeneous resulting in patients presenting to many different specialists, often with non-specific symptoms with a wide differential diagnosis. The pathophysiological mechanisms underlying this are poorly understood and the prediction of pathogenicity on the basis of gene mutation analysis can be problematic. While the availability of treatment adds an impetus to make the correct diagnosis, our understanding of when and if treatment may be required in a specific individual is incomplete. EXPERT OPINION Improving diagnostic rates of FD requires a greater awareness of the disorder among physicians to whom patients may present, new strategies to determine the pathogenicity of novel mutations and a greater understanding of the natural history of FD across the phenotypic spectrum. Collaborative clinical and laboratory research is vital in furthering knowledge of the underlying mechanisms of this disorder and how they may be impacted by current or future therapies.
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Affiliation(s)
- Alison S Thomas
- Royal Free Hospital and University College London Medical School, Lysosomal Storage Disorders Unit , London NW3 2QG , UK
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Abstract
Many patients have a few scattered angiokeratoma and we reassure them that this it is normal; however, if they are numerous, Fabry disease should be considered and the family history should be checked.
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Affiliation(s)
- Colm O’Mahony
- Department of Sexual Health & HIV, Countess of Chester Hospital, Chester, UK
| | - Andrea Franks
- Department of Dermatology, Countess of Chester Hospital, Chester, UK
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Böttcher T, Rolfs A, Tanislav C, Bitsch A, Köhler W, Gaedeke J, Giese AK, Kolodny EH, Duning T. Fabry disease - underestimated in the differential diagnosis of multiple sclerosis? PLoS One 2013; 8:e71894. [PMID: 24015197 PMCID: PMC3756019 DOI: 10.1371/journal.pone.0071894] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 07/04/2013] [Indexed: 11/19/2022] Open
Abstract
Objective Fabry disease is a rare X-linked inherited lysosomal storage disorder affecting multiple organ systems. It includes central nervous system involvement via micro- and macroangiopathic cerebral changes. Due to its clinical symptoms and frequent MRI lesions, Fabry disease is commonly misdiagnosed as multiple sclerosis. We present an overview of cases from Fabry centres in Germany initially misdiagnosed with multiple sclerosis and report the clinical, MR-tomographical, and laboratory findings. Methods Eleven Fabry patients (one male, ten females) initially diagnosed with multiple sclerosis were identified from 187 patient records (5.9%) and analyzed for presenting symptoms, results of the initial diagnostic workup, and the clinical course of the disease. Results Four patients were identified as having a “possible” history of MS, and 7 patients as “definite” cases of multiple sclerosis (revised McDonald criteria). On average, Fabry disease was diagnosed 8.2 years (±9.8 years) after the MS diagnosis, and 12.8 years after onset of first symptoms (±10.3 years). All patients revealed white matter lesions on MRI. The lesion pattern and results of cerebrospinal fluid examination were inconsistent and non-specific. White matter lesion volumes ranged from 8.9 mL to 34.8 mL (mean 17.8 mL±11.4 mL). There was no association between extra-neurological manifestations or enzyme activity and lesion load. Conclusion There are several anamnestic and clinical hints indicating when Fabry disease should be considered a relevant differential diagnosis of multiple sclerosis, e.g. female patients with asymmetric, confluent white matter lesions on MRI, normal spinal MR imaging, ectatic vertebrobasilar arteries, proteinuria, or lack of intrathecally derived immunoglobulin synthesis.
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Affiliation(s)
- Tobias Böttcher
- Albrecht Kossel Institute for Neuroregeneration, University of Rostock, Rostock, Germany ; Department of Neurology, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany
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FabryScan: a screening tool for early detection of Fabry disease. J Neurol 2012; 259:2393-400. [DOI: 10.1007/s00415-012-6619-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 06/04/2012] [Accepted: 07/11/2012] [Indexed: 01/08/2023]
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Burlina AP, Sims KB, Politei JM, Bennett GJ, Baron R, Sommer C, Møller AT, Hilz MJ. Early diagnosis of peripheral nervous system involvement in Fabry disease and treatment of neuropathic pain: the report of an expert panel. BMC Neurol 2011; 11:61. [PMID: 21619592 PMCID: PMC3126707 DOI: 10.1186/1471-2377-11-61] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 05/27/2011] [Indexed: 12/26/2022] Open
Abstract
Background Fabry disease is an inherited metabolic disorder characterized by progressive lysosomal accumulation of lipids in a variety of cell types, including neural cells. Small, unmyelinated nerve fibers are particularly affected and small fiber peripheral neuropathy often clinically manifests at young age. Peripheral pain can be chronic and/or occur as provoked attacks of excruciating pain. Manifestations of dysfunction of small autonomic fibers may include, among others, impaired sweating, gastrointestinal dysmotility, and abnormal pain perception. Patients with Fabry disease often remain undiagnosed until severe complications involving the kidney, heart, peripheral nerves and/or brain have arisen. Methods An international expert panel convened with the goal to provide guidance to clinicians who may encounter unrecognized patients with Fabry disease on how to diagnose these patients early using simple diagnostic tests. A further aim was to offer recommendations to control neuropathic pain. Results We describe the neuropathy in Fabry disease, focusing on peripheral small fiber dysfunction - the hallmark of early neurologic involvement in this disorder. The clinical course of peripheral pain is summarized, and the importance of medical history-taking, including family history, is highlighted. A thorough physical examination (e.g., angiokeratoma, corneal opacities) and simple non-invasive sensory perception tests could provide clues to the diagnosis of Fabry disease. Reported early clinical benefits of enzyme replacement therapy include reduction of neuropathic pain, and adequate management of residual pain to a tolerable and functional level can substantially improve the quality of life for patients. Conclusions Our recommendations can assist in diagnosing Fabry small fiber neuropathy early, and offer clinicians guidance in controlling peripheral pain. This is particularly important since management of pain in young patients with Fabry disease appears to be inadequate.
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Gambarin FI, Disabella E, Narula J, Diegoli M, Grasso M, Serio A, Favalli BMEV, Agozzino M, Tavazzi L, Fraser AG, Arbustini E. When should cardiologists suspect Anderson-Fabry disease? Am J Cardiol 2010; 106:1492-9. [PMID: 21059442 DOI: 10.1016/j.amjcard.2010.07.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 07/13/2010] [Accepted: 07/13/2010] [Indexed: 11/16/2022]
Abstract
Anderson-Fabry disease is a lysosomal storage disorder caused by α-galactosidase defects and progressive intracellular accumulation of globotriaosylceramide. The disease can be specifically treated with enzyme replacement therapy. Hemizygous men and heterozygous women can develop cardiac disease. Whereas men experience the most severe clinical phenotype, clinical presentation in women varies from asymptomatic to severely symptomatic. The characteristic cardiac phenotype is left ventricular hypertrophy mimicking sarcomeric hypertrophic cardiomyopathy or hypertensive heart disease. Early or prehypertrophy cardiac involvement may escape detection, unless electrocardiographic clues are present. The cardiac markers that raise suspicion of Anderson-Fabry disease include a short PR interval without a δ wave and a prolonged QRS interval, supraventricular and ventricular arrhythmias, and concentric left ventricular hypertrophy. Extracardiac features include renal failure, corneal deposits, and nervous, gastrointestinal, and cutaneous manifestations. Useful family data include cardiac and extracardiac traits in relatives and absence of male-to-male transmission. Symptoms are subtle, and the interval between the onset of symptoms and diagnosis may be as long as 20 years. As such, the diagnosis is typically late. Endomyocardial biopsy shows optically empty myocytes on light microscopy and dense osmiophilic bodies constituted of globotriaosylceramide on electron microscopy. Alpha-galactosidase A activity is reduced in hemizygous men but not in heterozygous women. Genetic testing is the gold standard for the diagnosis. In conclusion, a correct and timely diagnosis offers the possibility of disease-specific treatment that leads to sustained clinical benefits for cardiac and noncardiac signs and symptoms.
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Affiliation(s)
- Fabiana I Gambarin
- Centre for Inherited Cardiovascular Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Krumova EK, Westermann A, Maier C. Quantitative sensory testing: a diagnostic tool for painful neuropathy. FUTURE NEUROLOGY 2010. [DOI: 10.2217/fnl.10.48] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Quantitative sensory testing (QST) analyzes sensory perceptions of external stimuli of controlled intensity. Both large and small fiber function can be evaluated by applying thermal and mechanical stimuli, thus closing the diagnostic gap for the conventional electrophysiology in the examination of thin and unmyelinated nerve fibers. Detection, pain thresholds and stimulus–response curves can be determined; therefore, QST is a valuable diagnostic tool for identifying both sensory loss (i.e., hypoesthesia and hypoalgesia) and gain (i.e., hyperalgesia and allodynia) in patients with painful or painless neuropathy. Every psychophysical approach QST requires standardized stimuli administration, instructions and data evaluation to achieve valid results. QST can be used to evaluate distinct somatosensory profiles and thus give hints to the underlying mechanisms that occur with different frequencies in different pain syndromes. This might be helpful for the future establishment of mechanism-based pharmacotherapy. Since normative data are available, QST also contributes to the individual diagnosis of neuropathy. The present article gives an outline of QST application in diagnosis and its limitations for the evaluation of neuropathic pain.
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Affiliation(s)
| | - Andrea Westermann
- BG University Hospital Bergmannsheil GmbH Bochum, Department of Pain Management, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, D 44789 Bochum, Germany
| | - Christoph Maier
- BG University Hospital Bergmannsheil GmbH Bochum, Department of Pain Management, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, D 44789 Bochum, Germany
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Park KB, Han KR, Lee JW, Kim SH, Kim DW, Kim C, Ko JM. Early diagnosis of fabry disease in a patient with toe tip pain. Korean J Pain 2010; 23:207-10. [PMID: 20830268 PMCID: PMC2935984 DOI: 10.3344/kjp.2010.23.3.207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 07/29/2010] [Accepted: 07/29/2010] [Indexed: 01/29/2023] Open
Abstract
Fabry disease is an X-linked lysosomal disease caused by deficiency of α-galactosidase, in which early diagnosis may be missed due to the wide variety of clinical symptoms presenting during disease progression. A 13 year-old boy visited our pain clinic complaining of pricking and burning pain in the toe tips of both feet. Continuous epidural infusion for pain management was performed because of oral analgesics ineffectiveness. The patient underwent α-galactosidase A (GLA) enzyme analysis based on the clinical impression of Fabry disease from pain with a peripheral neuropathic component and history of anhidrosis. He was diagnosed with Fabry disease after confirming mutation of the GLA gene through a screening test of GLA activity. Enzyme replacement therapy was initiated and pain was tolerated with oral analgesics.
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Affiliation(s)
- Ki Bum Park
- Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu, Korea
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