1
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Pieroni M, Namdar M, Olivotto I, Desnick RJ. Anderson-Fabry disease management: role of the cardiologist. Eur Heart J 2024; 45:1395-1409. [PMID: 38486361 DOI: 10.1093/eurheartj/ehae148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 02/04/2024] [Accepted: 02/27/2024] [Indexed: 04/22/2024] Open
Abstract
Anderson-Fabry disease (AFD) is a lysosomal storage disorder characterized by glycolipid accumulation in cardiac cells, associated with a peculiar form of hypertrophic cardiomyopathy (HCM). Up to 1% of patients with a diagnosis of HCM indeed have AFD. With the availability of targeted therapies for sarcomeric HCM and its genocopies, a timely differential diagnosis is essential. Specifically, the therapeutic landscape for AFD is rapidly evolving and offers increasingly effective, disease-modifying treatment options. However, diagnosing AFD may be difficult, particularly in the non-classic phenotype with prominent or isolated cardiac involvement and no systemic red flags. For many AFD patients, the clinical journey from initial clinical manifestations to diagnosis and appropriate treatment remains challenging, due to late recognition or utter neglect. Consequently, late initiation of treatment results in an exacerbation of cardiac involvement, representing the main cause of morbidity and mortality, irrespective of gender. Optimal management of AFD patients requires a dedicated multidisciplinary team, in which the cardiologist plays a decisive role, ranging from the differential diagnosis to the prevention of complications and the evaluation of timing for disease-specific therapies. The present review aims to redefine the role of cardiologists across the main decision nodes in contemporary AFD clinical care and drug discovery.
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Affiliation(s)
- Maurizio Pieroni
- Cardiovascular Department, San Donato Hospital, Via Pietro Nenni 22, 52100 Arezzo, Italy
| | - Mehdi Namdar
- Cardiology Division, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi Hospital and Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Robert J Desnick
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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2
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Lerario S, Monti L, Ambrosetti I, Luglio A, Pietra A, Aiello V, Montanari F, Bellasi A, Zaza G, Galante A, Salera D, Capelli I, La Manna G, Provenzano M. Fabry disease: a rare disorder calling for personalized medicine. Int Urol Nephrol 2024:10.1007/s11255-024-04042-4. [PMID: 38613662 DOI: 10.1007/s11255-024-04042-4] [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: 02/15/2024] [Accepted: 03/25/2024] [Indexed: 04/15/2024]
Abstract
Fabry Disease (FD) is a genetic disease caused by a deficiency in the activity of lysosomal galactosidase A (α-GalA), an enzyme responsible for the catabolism of globotriaosylceramide (Gb3). Since lysosomes are present throughout the body and play a crucial role in catabolism and recycling of cytosolic compounds, FD can affect multiple organs and result in various symptoms, including renal, cardiovascular, neurological, cutaneous, and ophthalmic manifestations. Due to the nonspecific symptoms and the rarity of FD, it is often diagnosed late in life. However, introducing targeted therapies such as enzyme replacement therapy (ERT) and chaperone therapy has significantly improved FD's natural history and prognosis by restoring α-GalA enzyme activity. Despite the advancements, there are limitations to the currently available therapies, which has prompted research into new potential treatments for FD, including alternative forms of enzyme replacement therapy, substrate reduction therapy, mRNA therapy, and genetic therapy. In this review, we analyze the epidemiology, pathophysiology, and treatment of FD, with particular emphasis on promising therapeutic opportunities that could shift the treatment of this rare disease from a standardized to a personalized approach soon.
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Affiliation(s)
- Sarah Lerario
- Nephrology, Dialysis, and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Luigi Monti
- Medical Genetics Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Irene Ambrosetti
- Medical Genetics Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Agnese Luglio
- Medical Genetics Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Andrea Pietra
- Medical Genetics Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Valeria Aiello
- Nephrology, Dialysis, and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Francesca Montanari
- Medical Genetics Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Antonio Bellasi
- Servizio Di Nefrologia, Ospedale Regionale Di Lugano, Ente Ospedaliero Cantonale, Ospedale CivicoVia Tesserete 46, 6903, Lugano, Switzerland
- Università Della Svizzera Italiana (USI), Lugano, Switzerland
| | - Gianluigi Zaza
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036, Rende, CS, Italy
| | - Antonio Galante
- Università Della Svizzera Italiana (USI), Lugano, Switzerland
| | - Davide Salera
- Servizio Di Nefrologia, Ospedale Regionale Di Lugano, Ente Ospedaliero Cantonale, Ospedale CivicoVia Tesserete 46, 6903, Lugano, Switzerland
| | - Irene Capelli
- Nephrology, Dialysis, and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.
| | - Gaetano La Manna
- Nephrology, Dialysis, and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.
| | - Michele Provenzano
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036, Rende, CS, Italy
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3
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Mackels L, Servais L. The Importance of Early Treatment of Inherited Neuromuscular Conditions. J Neuromuscul Dis 2024; 11:253-274. [PMID: 38306060 DOI: 10.3233/jnd-230189] [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] [Indexed: 02/03/2024]
Abstract
There has been tremendous progress in treatment of neuromuscular diseases over the last 20 years, which has transformed the natural history of these severely debilitating conditions. Although the factors that determine the response to therapy are many and in some instance remain to be fully elucidated, early treatment clearly has a major impact on patient outcomes across a number of inherited neuromuscular conditions. To improve patient care and outcomes, clinicians should be aware of neuromuscular conditions that require prompt treatment initiation. This review describes data that underscore the importance of early treatment of children with inherited neuromuscular conditions with an emphasis on data resulting from newborn screening efforts.
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Affiliation(s)
- Laurane Mackels
- MDUK Oxford Neuromuscular Centre, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- Adult Neurology Department, Citadelle Hospital, Liège, Belgium
| | - Laurent Servais
- Neuromuscular Centre, Division of Paediatrics, University and University Hospital of Liège, Liège, Belgium
- MDUK Oxford Neuromuscular Centre, Department of Paediatrics, University of Oxford & NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
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4
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Esposito P, Caputo C, Repetto M, Somaschini A, Pietro B, Colomba P, Zizzo C, Parodi A, Zanetti V, Canepa M, Eustachi V, Sanguineri F, Mandich P, Viazzi F. Diagnosing Fabry nephropathy: the challenge of multiple kidney disease. BMC Nephrol 2023; 24:344. [PMID: 37990184 PMCID: PMC10664682 DOI: 10.1186/s12882-023-03388-8] [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: 09/27/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023] Open
Abstract
Fabry disease (FD) is an X-linked inherited lysosomal disorder due to a deficiency of the enzyme alpha-galactosidase A (α-gla) due to mutations in the GLA gene. These mutations result in plasma and lysosome accumulation of glycosphingolipids, leading to progressive organ damage and reduced life expectancy. Due to the availability of specific disease-modifying treatments, proper and timely diagnosis and therapy are essential to prevent irreversible complications. However, diagnosis of FD is often delayed because of the wide clinical heterogeneity of the disease and multiple organ involvement developing in variable temporal sequences. This observation is also valid for renal involvement, which may manifest with non-specific signs, such as proteinuria and chronic kidney disease, which are also common in many other nephropathies. Moreover, an additional confounding factor is the possibility of the coexistence of FD with other kidney disorders. Thus, suspecting and diagnosing FD nephropathy in patients with signs of kidney disease may be challenging for the clinical nephrologist. Herein, also through the presentation of a unique case of co-occurrence of autosomal dominant polycystic kidney disease and FD, we review the available literature on cases of coexistence of FD and other renal diseases and discuss the implications of these conditions. Moreover, we highlight the clinical, laboratory, and histological elements that may suggest clinical suspicion and address a proper diagnosis of Fabry nephropathy.
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Affiliation(s)
- Pasquale Esposito
- Department of Internal Medicine, University of Genoa, Genoa, Italy.
- Unit of Nephrology, Dialysis, and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Carmela Caputo
- Unit of Nephrology and Dialysis, Ospedale San Paolo, Savona, Italy
| | - Monica Repetto
- Unit of Nephrology and Dialysis, Ospedale San Paolo, Savona, Italy
| | - Alberto Somaschini
- Division of Cardiology and Cardiac Intensive Care Unit, Ospedale San Paolo, Savona, Italy
| | - Bellone Pietro
- Division of Cardiology and Cardiac Intensive Care Unit, Ospedale San Paolo, Savona, Italy
| | - Paolo Colomba
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), Palermo, Italy
| | - Carmela Zizzo
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), Palermo, Italy
| | - Angelica Parodi
- Unit of Nephrology, Dialysis, and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Valentina Zanetti
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Unit of Nephrology, Dialysis, and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marco Canepa
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Virginia Eustachi
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesca Sanguineri
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy
| | - Paola Mandich
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Unit of Nephrology, Dialysis, and Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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5
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Delaleu N, Marti HP, Strauss P, Sekulic M, Osman T, Tøndel C, Skrunes R, Leh S, Svarstad E, Nowak A, Gaspert A, Rusu E, Kwee I, Rinaldi A, Flatberg A, Eikrem O. Systems analyses of the Fabry kidney transcriptome and its response to enzyme replacement therapy identified and cross-validated enzyme replacement therapy-resistant targets amenable to drug repurposing. Kidney Int 2023; 104:803-819. [PMID: 37419447 DOI: 10.1016/j.kint.2023.06.029] [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: 06/03/2022] [Revised: 05/19/2023] [Accepted: 06/22/2023] [Indexed: 07/09/2023]
Abstract
Fabry disease is a rare disorder caused by variations in the alpha-galactosidase gene. To a degree, Fabry disease is manageable via enzyme replacement therapy (ERT). By understanding the molecular basis of Fabry nephropathy (FN) and ERT's long-term impact, here we aimed to provide a framework for selection of potential disease biomarkers and drug targets. We obtained biopsies from eight control individuals and two independent FN cohorts comprising 16 individuals taken prior to and after up to ten years of ERT, and performed RNAseq analysis. Combining pathway-centered analyses with network-science allowed computation of transcriptional landscapes from four nephron compartments and their integration with existing proteome and drug-target interactome data. Comparing these transcriptional landscapes revealed high inter-cohort heterogeneity. Kidney compartment transcriptional landscapes comprehensively reflected differences in FN cohort characteristics. With exception of a few aspects, in particular arteries, early ERT in patients with classical Fabry could lastingly revert FN gene expression patterns to closely match that of control individuals. Pathways nonetheless consistently altered in both FN cohorts pre-ERT were mostly in glomeruli and arteries and related to the same biological themes. While keratinization-related processes in glomeruli were sensitive to ERT, a majority of alterations, such as transporter activity and responses to stimuli, remained dysregulated or reemerged despite ERT. Inferring an ERT-resistant genetic module of expressed genes identified 69 drugs for potential repurposing matching the proteins encoded by 12 genes. Thus, we identified and cross-validated ERT-resistant gene product modules that, when leveraged with external data, allowed estimating their suitability as biomarkers to potentially track disease course or treatment efficacy and potential targets for adjunct pharmaceutical treatment.
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Affiliation(s)
- Nicolas Delaleu
- 2cSysBioMed, Contra, Switzerland; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hans-Peter Marti
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Philipp Strauss
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Miroslav Sekulic
- Department of Pathology and Cell Biology, Columbia University, New York, New York, USA
| | - Tarig Osman
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Camilla Tøndel
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Rannveig Skrunes
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Sabine Leh
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Einar Svarstad
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Albina Nowak
- Department of Endocrinology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Ariana Gaspert
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Elena Rusu
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania; Department of Nephrology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ivo Kwee
- BigOmics Analytics, Lugano, Switzerland
| | - Andrea Rinaldi
- Institute of Oncology Research, Oncology Institute of Southern Switzerland, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Arnar Flatberg
- Central Administration, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Oystein Eikrem
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Medicine, Haukeland University Hospital, Bergen, Norway.
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6
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van der Veen SJ, el Sayed M, Hollak CE, Brands MM, Snelder CKS, Boekholdt SM, Vogt L, Goorden SM, van Kuilenburg AB, Langeveld M. Early Risk Stratification for Natural Disease Course in Fabry Patients Using Plasma Globotriaosylsphingosine Levels. Clin J Am Soc Nephrol 2023; 18:1272-1282. [PMID: 37499686 PMCID: PMC10578638 DOI: 10.2215/cjn.0000000000000239] [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: 01/13/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Fabry disease is a very heterogeneous X-linked lysosomal storage disease. Disease manifestations in the kidneys, heart, and brain vary greatly, even between patients of the same sex and with the same disease classification (classical or nonclassical). A biomarker with a strong association with the development of disease manifestations is needed to determine the need for Fabry-specific treatment and appropriate frequency of follow-up because clinical manifestations of the disorder may take decennia to develop. METHODS We investigated the levels of plasma lysoGb3 levels over time and its association with disease manifestations and disease course in 237 untreated patients with Fabry disease (median age 42 years, 38% male) using linear mixed-effect models. RESULTS LysoGb3 levels are stable over time in plasma of untreated patients with Fabry disease. Higher levels of lysoGb3 were associated with steeper decline in eGFR ( P = 0.05) and a faster increase in albuminuria (measured as the urinary albumin-to-creatinine ratio, P < 0.001), left ventricular mass (measured on echocardiography, P < 0.001), left atrial volume index ( P = 0.003), and Fazekas score ( P = 0.003). In addition, regardless of age, higher lysoGb3 levels were associated with higher relative wall thickness ( P < 0.001) and unfavorable functional markers on echocardiography, including septal mitral annular early diastolic velocity (e', P < 0.001) and the ratio of early transmitral velocity (E) to e' (E/e', P = 0.001). CONCLUSIONS In an individual patient with Fabry disease, the plasma lysoGb3 level reached a specific level in early childhood which, in the absence of Fabry-specific treatment, remained stable throughout life. The level of lysoGb3 in untreated patients was associated with nearly all Fabry-specific disease manifestations, regardless of the sex of the patient.
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Affiliation(s)
- Sanne J. van der Veen
- Department of Endocrinology and Metabolism, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Mohamed el Sayed
- Department of Endocrinology and Metabolism, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Carla E.M. Hollak
- Department of Endocrinology and Metabolism, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Marion M. Brands
- Division of Metabolic Diseases, Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - C. Khya S. Snelder
- Department of Endocrinology and Metabolism, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - S. Matthijs Boekholdt
- Department of Cardiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Liffert Vogt
- Department of Nephrology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Susan M.I. Goorden
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, The Netherlands
- Laboratory Genetic Metabolic Diseases, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - André B.P. van Kuilenburg
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, The Netherlands
- Laboratory Genetic Metabolic Diseases, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Mirjam Langeveld
- Department of Endocrinology and Metabolism, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
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7
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Girolami F, Gozzini A, Pálinkás ED, Ballerini A, Tomberli A, Baldini K, Marchi A, Zampieri M, Passantino S, Porcedda G, Calabri GB, Bennati E, Spaziani G, Crotti L, Cecchi F, Favilli S, Olivotto I. Genetic Testing and Counselling in Hypertrophic Cardiomyopathy: Frequently Asked Questions. J Clin Med 2023; 12:jcm12072489. [PMID: 37048573 PMCID: PMC10095452 DOI: 10.3390/jcm12072489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/13/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Genetic counselling and genetic testing in hypertrophic cardiomyopathy (HCM) represent an integral part of the diagnostic algorithm to confirm the diagnosis, distinguish it from phenocopies, and suggest tailored therapeutic intervention strategies. Additionally, they enable cascade genetic testing in the family. With the implementation of Next Generation Sequencing technologies (NGS), the interpretation of genetic data has become more complex. In this regard, cardiologists play a central role, aiding geneticists to correctly evaluate the pathogenicity of the identified genetic alterations. In the ideal setting, geneticists and cardiologists must work side by side to diagnose HCM as well as convey the correct information to patients in response to their many questions and concerns. After a brief overview of the role of genetics in the diagnosis of HCM, we present and discuss the frequently asked questions by HCM patients throughout our 20-year genetic counselling experience. Appropriate communication between the team and the families is key to the goal of delivering the full potential of genetic testing to our patients.
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Affiliation(s)
- Francesca Girolami
- Pediatric Cardiology Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy
- Correspondence:
| | - Alessia Gozzini
- Pediatric Cardiology Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy
| | - Eszter Dalma Pálinkás
- Doctoral School of Clinical Medicine, University of Szeged, 6720 Szeged, Hungary
- Cardiomyopathy Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Adelaide Ballerini
- Pediatric Cardiology Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy
| | - Alessia Tomberli
- Pediatric Cardiology Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy
| | - Katia Baldini
- Cardiomyopathy Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Alberto Marchi
- Pediatric Cardiology Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy
| | - Mattia Zampieri
- Pediatric Cardiology Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy
| | - Silvia Passantino
- Pediatric Cardiology Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy
| | - Giulio Porcedda
- Pediatric Cardiology Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy
| | | | - Elena Bennati
- Pediatric Cardiology Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy
| | - Gaia Spaziani
- Pediatric Cardiology Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy
| | - Lia Crotti
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, 20100 Milan, Italy
- Department of Medicine and Surgery, University Milano Bicocca, 20126 Milan, Italy
| | - Franco Cecchi
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, 20100 Milan, Italy
| | - Silvia Favilli
- Pediatric Cardiology Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy
| | - Iacopo Olivotto
- Pediatric Cardiology Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
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8
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Hallows WC, Skvorak K, Agard N, Kruse N, Zhang X, Zhu Y, Botham RC, Chng C, Shukla C, Lao J, Miller M, Sero A, Viduya J, Ismaili MHA, McCluskie K, Schiffmann R, Silverman AP, Shen JS, Huisman GW. Optimizing human α-galactosidase for treatment of Fabry disease. Sci Rep 2023; 13:4748. [PMID: 36959353 PMCID: PMC10036536 DOI: 10.1038/s41598-023-31777-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/17/2023] [Indexed: 03/25/2023] Open
Abstract
Fabry disease is caused by a deficiency of α-galactosidase A (GLA) leading to the lysosomal accumulation of globotriaosylceramide (Gb3) and other glycosphingolipids. Fabry patients experience significant damage to the heart, kidney, and blood vessels that can be fatal. Here we apply directed evolution to generate more stable GLA variants as potential next generation treatments for Fabry disease. GLAv05 and GLAv09 were identified after screening more than 12,000 GLA variants through 8 rounds of directed evolution. Both GLAv05 and GLAv09 exhibit increased stability at both lysosomal and blood pH, stability to serum, and elevated enzyme activity in treated Fabry fibroblasts (19-fold) and GLA-/- podocytes (10-fold). GLAv05 and GLAv09 show improved pharmacokinetics in mouse and non-human primates. In a Fabry mouse model, the optimized variants showed prolonged half-lives in serum and relevant tissues, and a decrease of accumulated Gb3 in heart and kidney. To explore the possibility of diminishing the immunogenic potential of rhGLA, amino acid residues in sequences predicted to bind MHC II were targeted in late rounds of GLAv09 directed evolution. An MHC II-associated peptide proteomics assay confirmed a reduction in displayed peptides for GLAv09. Collectively, our findings highlight the promise of using directed evolution to generate enzyme variants for more effective treatment of lysosomal storage diseases.
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Affiliation(s)
| | - Kristen Skvorak
- Codexis Inc.,, 200 Penobscot Drive, Redwood City, CA, 94063, USA
| | - Nick Agard
- Codexis Inc.,, 200 Penobscot Drive, Redwood City, CA, 94063, USA
- Genentech, South San Francisco, CA, 94080, USA
| | - Nikki Kruse
- Codexis Inc.,, 200 Penobscot Drive, Redwood City, CA, 94063, USA
| | - Xiyun Zhang
- Codexis Inc.,, 200 Penobscot Drive, Redwood City, CA, 94063, USA
- Fornia BioSolutions Inc US, Hayward, CA, 94545, USA
| | - Yu Zhu
- Codexis Inc.,, 200 Penobscot Drive, Redwood City, CA, 94063, USA
| | - Rachel C Botham
- Codexis Inc.,, 200 Penobscot Drive, Redwood City, CA, 94063, USA
| | - Chinping Chng
- Codexis Inc.,, 200 Penobscot Drive, Redwood City, CA, 94063, USA
| | - Charu Shukla
- Codexis Inc.,, 200 Penobscot Drive, Redwood City, CA, 94063, USA
| | - Jessica Lao
- Codexis Inc.,, 200 Penobscot Drive, Redwood City, CA, 94063, USA
- Octant, Emeryville, CA, 94608, USA
| | - Mathew Miller
- Codexis Inc.,, 200 Penobscot Drive, Redwood City, CA, 94063, USA
| | - Antoinette Sero
- Codexis Inc.,, 200 Penobscot Drive, Redwood City, CA, 94063, USA
| | - Judy Viduya
- Codexis Inc.,, 200 Penobscot Drive, Redwood City, CA, 94063, USA
| | - Moulay Hicham Alaoui Ismaili
- Codexis Inc.,, 200 Penobscot Drive, Redwood City, CA, 94063, USA
- Glycomine, San Mateo, CA, 94070, USA
| | - Kerryn McCluskie
- Codexis Inc.,, 200 Penobscot Drive, Redwood City, CA, 94063, USA
- Glycomine, San Mateo, CA, 94070, USA
| | - Raphael Schiffmann
- Institute of Metabolic Disease, Baylor Research Institute, Dallas, TX, 75246, USA
- 4D Molecular Therapeutics, Emeryville, CA, 94608, USA
| | - Adam P Silverman
- Codexis Inc.,, 200 Penobscot Drive, Redwood City, CA, 94063, USA
| | - Jin-Song Shen
- Institute of Metabolic Disease, Baylor Research Institute, Dallas, TX, 75246, USA
- 4D Molecular Therapeutics, Emeryville, CA, 94608, USA
| | - Gjalt W Huisman
- Codexis Inc.,, 200 Penobscot Drive, Redwood City, CA, 94063, USA
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Critchley BJ, Gaspar HB, Benedetti S. Targeting the central nervous system in lysosomal storage diseases: Strategies to deliver therapeutics across the blood-brain barrier. Mol Ther 2023; 31:657-675. [PMID: 36457248 PMCID: PMC10014236 DOI: 10.1016/j.ymthe.2022.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/18/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022] Open
Abstract
Lysosomal storage diseases (LSDs) are multisystem inherited metabolic disorders caused by dysfunctional lysosomal activity, resulting in the accumulation of undegraded macromolecules in a variety of organs/tissues, including the central nervous system (CNS). Treatments include enzyme replacement therapy, stem/progenitor cell transplantation, and in vivo gene therapy. However, these treatments are not fully effective in treating the CNS as neither enzymes, stem cells, nor viral vectors efficiently cross the blood-brain barrier. Here, we review the latest advancements in improving delivery of different therapeutic agents to the CNS and comment upon outstanding questions in the field of neurological LSDs.
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Affiliation(s)
- Bethan J Critchley
- Infection, Immunity and Inflammation Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, Zayed Centre for Research, London WC1N 1DZ, UK
| | - H Bobby Gaspar
- Infection, Immunity and Inflammation Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, Zayed Centre for Research, London WC1N 1DZ, UK; Orchard Therapeutics Ltd., London EC4N 6EU, UK
| | - Sara Benedetti
- Infection, Immunity and Inflammation Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, Zayed Centre for Research, London WC1N 1DZ, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK.
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10
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Muto R, Suzuki Y, Shimizu H, Yasuda K, Ishimoto T, Maruyama S, Ito Y, Mizuno M. Recurrent Cerebrovascular Complications under Enzyme Replacement Therapy in a Patient with Fabry Disease on Peritoneal Dialysis. Intern Med 2023; 62:565-569. [PMID: 35831104 PMCID: PMC10017251 DOI: 10.2169/internalmedicine.0185-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Fabry disease is an X-linked lysosomal storage disorder due to mutations in the alpha-galactosidase A gene, which leads to the accumulation of globotriaosylceramide in various organs. In Fabry disease with end-stage renal disease (ESRD), cerebrovascular events are lethal, even with enzyme replacement therapy (ERT). However, the utility of biomarkers to evaluate the ERT response is unclear. We herein report a case of recurrent cerebrovascular complications under ERT in a Fabry disease patient, progressing to ESRD on peritoneal dialysis. Further studies are warranted, but Fabry disease patients with ESRD receiving ERT might need careful long-term follow-up in cases with cerebrovascular manifestations.
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Affiliation(s)
- Reiko Muto
- Department of Nephrology, Nagoya University Graduate School of Medicine, Japan
- Department of Molecular Medicine and Metabolism, Research Institute of Environmental Medicine, Nagoya University, Japan
| | - Yasuhiro Suzuki
- Department of Nephrology, Nagoya University Graduate School of Medicine, Japan
- Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Japan
| | | | | | - Takuji Ishimoto
- Department of Nephrology, Nagoya University Graduate School of Medicine, Japan
- Department of Nephrology and Rheumatology, Aichi Medical University, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Japan
| | - Yasuhiko Ito
- Department of Nephrology and Rheumatology, Aichi Medical University, Japan
| | - Masashi Mizuno
- Department of Nephrology, Nagoya University Graduate School of Medicine, Japan
- Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Japan
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11
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Hopkin RJ, Cabrera GH, Jefferies JL, Yang M, Ponce E, Brand E, Feldt-Rasmussen U, Germain DP, Guffon N, Jovanovic A, Kantola I, Karaa A, Martins AM, Tøndel C, Wilcox WR, Yoo HW, Burlina AP, Mauer M. Clinical outcomes among young patients with Fabry disease who initiated agalsidase beta treatment before 30 years of age: An analysis from the Fabry Registry. Mol Genet Metab 2023; 138:106967. [PMID: 36709533 DOI: 10.1016/j.ymgme.2022.106967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/26/2022] [Accepted: 11/26/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Clinical manifestations of classic Fabry disease (α-galactosidase A deficiency) usually occur in childhood, while complications involving major organs typically develop in adulthood. Outcomes of Fabry-specific treatment among young patients have not been extensively reported. Our aim was to analyze clinical outcomes among patients aged 5-30 years at initiation of treatment with agalsidase beta using data from the Fabry Registry (NCT00196742, sponsor: Sanofi). METHODS Reported GLA variants were predicted to be associated with the classic phenotype or not classified in fabry-database.org. Linear mixed models were conducted to assess changes over ≥2-year follow-up in the estimated glomerular filtration rate (eGFR) stratified by low (LRI) and high (HRI) renal involvement (defined by proteinuria/albuminuria levels), and changes in interventricular septal thickness (IVST) and left ventricular posterior wall thickness (LVPWT) Z-scores stratified by median age at first treatment. Self-reports ('yes'/'no') of abdominal pain, diarrhea, chronic peripheral pain (denoting neuropathic pain), and acute pain crises at baseline were compared with reports after ≥0.5-year and ≥2.5-year follow-up using McNemar's test. RESULTS Male (n = 117) and female patients (n = 59) with LRI initiated treatment at a median age of 19.9 and 23.6 years, respectively, and were followed for a median of 6.3 and 5.0 years, respectively. The eGFR slopes were -1.18 (Pfrom 0 <0.001) and -0.92 mL/min/1.73 m2/year (Pfrom 0 = 0.040), respectively. Males with HRI (n = 23, median UPCR 1.0 g/g), who started treatment at a median age of 26.7 years, had an eGFR slope of -2.39 mL/min/1.73 m2/year (Pfrom 0 <0.001; Pdifference = 0.055, as compared with the slope of -1.18 mL/min/1.73 m2/year for LRI males) during a median follow-up of 5.6 years. Echocardiographic variables were stable among males, regardless of age, and among young females (median follow-up >5.5 years and ≥4.5 years, respectively). Older females (treatment initiation at median age 27.5 years) had a slope of LVPWT Z-scores of 0.18/year (n = 12, Pfrom 0 = 0.028), whereas IVST Z-scores remained stable (n = 13, 0.10/year, Pfrom 0 = 0.304) during a median follow-up of ≥3.7 years. These slopes did not significantly differ from slopes of younger females. Reports of chronic peripheral pain and acute pain crises by males, and of diarrhea and acute pain crises by females, significantly reduced after a median follow-up of ≥4.0 years. After a median follow-up of ≥5.4 years, reports of all four symptoms significantly decreased among males, whereas among females only reports of abdominal pain significantly decreased. CONCLUSIONS During sustained treatment with agalsidase beta in young Fabry patients with a predicted classic phenotype or with unclassified GLA variants with similar characteristics, the decline in eGFR was modest among male and female patients with LRI. The greater decline in eGFR among older, proteinuric (i.e., HRI) males may suggest a benefit of earlier treatment. Overall, echocardiographic variables remained stable, particularly among males and younger females. Significant reductions in symptom reports occurred primarily among males after longer follow-up and were less noticeable among females. These observed trends are suggestive of an overall improvement after treatment in young patients, but warrant larger longitudinal studies.
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Affiliation(s)
- Robert J Hopkin
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | | | - John L Jefferies
- The Cardiovascular Institute, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | | | - Eva Brand
- Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, University Hospital Münster, Münster, Germany
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, and Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Dominique P Germain
- French Referral Center for Fabry disease, Division of Medical Genetics, University of Versailles and APHP - Paris Saclay University, Garches, France
| | - Nathalie Guffon
- Centre de Référence des Maladies Héréditaires du Métabolisme, Hôpital Femme Mère Enfant, Bron Cedex, France
| | - Ana Jovanovic
- Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - Ilkka Kantola
- Division of Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Amel Karaa
- Department of Genetics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ana M Martins
- Reference Center for Inborn Errors of Metabolism, Federal University of São Paulo, São Paulo, Brazil
| | - Camilla Tøndel
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway, and Department of Clinical Science, University of Bergen, Bergen, Norway
| | - William R Wilcox
- Division of Medical Genetics, Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Han-Wook Yoo
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | - Michael Mauer
- Departments of Pediatrics and Medicine, University of Minnesota, Minneapolis, MN, USA
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Taguchi A, Ishii S, Mikame M, Maruyama H. Distinctive accumulation of globotriaosylceramide and globotriaosylsphingosine in a mouse model of classic Fabry disease. Mol Genet Metab Rep 2023; 34:100952. [PMID: 36624895 PMCID: PMC9823212 DOI: 10.1016/j.ymgmr.2022.100952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
Fabry disease (FD) is an inherited disease caused by deficient α-galactosidase A activity that is characterized by the accumulation of globotriaosylceramide (Gb3) and globotriaosylsphingosine (lyso-Gb3). Although plasma lyso-Gb3 is a sensitive biomarker of FD, the correlation between its concentration and clinical symptoms remains unclear. To clarify the influence of plasma Gb3 and lyso-Gb3 in a symptomatic Gla tm Tg(CAG-A4GALT) FD mouse model, the total contents of Gb3, lyso-Gb3 and their analogs in various organs and plasma were determined in mice with early- (5-week-old) and late-stage (20-week-old) renal dysfunction. A marked increase in total Gb3 content in the heart, kidneys, spleen, liver, small intestine, lungs, brain, and plasma was observed in the 20-week-old mice compared to that in 5-week-old mice. In contrast, the increase in lyso-Gb3 was relatively small, and the total content in the lungs and plasma was unchanged. Lyso-Gb3 analogs {lyso-Gb3(-2) and lyso-Gb3(+18)} and Gb3 analogs {Gb3(-2) and Gb3(+18)} were observed in all organs and plasma at both ages, and the percentages of the analogs were unique to specific organs. The pattern of 37 Gb3 analogs/isoforms of liver Gb3 corresponded well with that of plasma Gb3. Although the analog pattern of plasma lyso-Gb3 did not resemble that of any organ lyso-Gb3, the relative content {lyso-Gb3: lyso-Gb3(-2)} in the sum of all organs corresponded well to that of the plasma at both ages. These data indicate that liver Gb3 may contribute to the plasma Gb3 level, while plasma lyso-Gb3 may be released from all organs, and the capacity of the plasma lyso-Gb3 pool may reach a maximum at an early stage of renal dysfunction.
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Key Words
- ACN, acetonitrile
- Analog
- ERT, Enzyme replacement therapy
- FA, formic acid
- FD, Fabry disease
- Fabry disease
- GLA, α-galactosidase A
- Gb3, globotriaosylceramide
- GlatmTg(CAG-A4GALT) Fabry mouse model
- Globotriaosylceramide
- Globotriaosylsphingosine
- IPA, isopropyl alcohol
- MeOH, methanol
- PCT, pharmacological chaperone therapy
- UPLC-MS/MS, ultra-performance liquid chromatography coupled to tandem MS.
- lyso-Gb3, globotriaosylsphingosine
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Affiliation(s)
- Atsumi Taguchi
- Department of Clinical Nephroscience, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Satoshi Ishii
- Department of Matrix Medicine, Faculty of Medicine, Oita University, Oita, Japan
- Biochemical Laboratory, GlycoPharma Corporation, Oita, Japan
- Corresponding author at: Department of Matrix Medicine, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita 897-5593, Japan.
| | - Mariko Mikame
- Department of Clinical Nephroscience, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hiroki Maruyama
- Department of Clinical Nephroscience, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Palaiodimou L, Kokotis P, Zompola C, Papagiannopoulou G, Bakola E, Papadopoulou M, Zouvelou V, Petras D, Vlachopoulos C, Tsivgoulis G. Fabry Disease: Current and Novel Therapeutic Strategies. A Narrative Review. Curr Neuropharmacol 2023; 21:440-456. [PMID: 35652398 PMCID: PMC10207921 DOI: 10.2174/1570159x20666220601124117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/11/2022] [Accepted: 05/20/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Fabry disease (FD) is an inherited lysosomal storage disorder, leading to multisystemic manifestations and causing significant morbidity and mortality. OBJECTIVE The aim of this narrative review is to present the current and novel therapeutic strategies in FD, including symptomatic and specific treatment options. METHODS A systematic literature search was conducted to identify relevant studies, including completed and ongoing randomized-controlled clinical trials (RCTs), prospective or retrospective cohort studies, case series and case reports that provided clinical data regarding FD treatment. RESULTS A multidisciplinary symptomatic treatment is recommended for FD patients, personalized according to disease manifestations and their severity. During the last two decades, FD-specific treatments, including two enzyme-replacement-therapies (agalsidase alfa and agalsidase beta) and chaperone treatment with migalastat have been approved for use and allowed for symptoms' stabilization or even disease burden reduction. More therapeutic agents are currently under investigation. Substrate reduction therapies, including lucerastat and venglustat, have shown promising results in RCTs and may be used either as monotherapy or as complementary therapy to established enzymereplacement- therapies. More stable enzyme-replacement-therapy molecules that are associated with less adverse events and lower likelihood of neutralizing antibodies formation have also been developed. Ex-vivo and in-vivo gene therapy is being tested in animal models and pilot human clinical trials, with preliminary results showing a favorable safety and efficacy profile. CONCLUSION The therapeutic landscape in FD appears to be actively expanding with more treatment options expected to become available in the near future, allowing for a more personalized approach in FD patients.
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Affiliation(s)
- Lina Palaiodimou
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Kokotis
- First Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, Athens, Greece
| | - Christina Zompola
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Papagiannopoulou
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Bakola
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianna Papadopoulou
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki Zouvelou
- First Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, Athens, Greece
| | - Dimitrios Petras
- Nephrology Department, Hippokration General Hospital, Athens, Greece
| | | | - Georgios Tsivgoulis
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
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14
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Li X, Ren X, Zhang Y, Ding L, Huo M, Li Q. Fabry disease: Mechanism and therapeutics strategies. Front Pharmacol 2022; 13:1025740. [PMID: 36386210 PMCID: PMC9643830 DOI: 10.3389/fphar.2022.1025740] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/10/2022] [Indexed: 12/04/2022] Open
Abstract
Fabry disease is a monogenic disease characterized by a deficiency or loss of the α-galactosidase A (GLA). The resulting impairment in lysosomal GLA enzymatic activity leads to the pathogenic accumulation of enzymatic substrate and, consequently, the progressive appearance of clinical symptoms in target organs, including the heart, kidney, and brain. However, the mechanisms involved in Fabry disease-mediated organ damage are largely ambiguous and poorly understood, which hinders the development of therapeutic strategies for the treatment of this disorder. Although currently available clinical approaches have shown some efficiency in the treatment of Fabry disease, they all exhibit limitations that need to be overcome. In this review, we first introduce current mechanistic knowledge of Fabry disease and discuss potential therapeutic strategies for its treatment. We then systemically summarize and discuss advances in research on therapeutic approaches, including enzyme replacement therapy (ERT), gene therapy, and chaperone therapy, as well as strategies targeting subcellular compartments, such as lysosomes, the endoplasmic reticulum, and the nucleus. Finally, the future development of potential therapeutic strategies is discussed based on the results of mechanistic studies and the limitations associated with these therapeutic approaches.
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Affiliation(s)
- Xi Li
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Xiangyi Ren
- Core Facilities of West China Hospital, Sichuan University, Chengdu, China
| | - Yabing Zhang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Lin Ding
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Minfeng Huo
- Shanghai Tenth People’s Hospital, Shanghai Frontiers Science Center of Nanocatalytic Medicine, School of Medicine, Tongji University, Shanghai, China
- *Correspondence: Qian Li, ; Minfeng Huo,
| | - Qian Li
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
- *Correspondence: Qian Li, ; Minfeng Huo,
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Nowak A, Dormond O, Monzambani V, Huynh-Do U, Barbey F. Agalsidase-β should be proposed as first line therapy in classic male Fabry patients with undetectable α-galactosidase A activity. Mol Genet Metab 2022; 137:173-178. [PMID: 36087505 DOI: 10.1016/j.ymgme.2022.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Fabry disease (FD) is a rare X-linked lysosomal storage disease caused by mutations in the α-galactosidase A (GLA) gene leading to deficiency of α-galactosidase A (α-gal A). This results in progressive multisystemic glycosphingolipid accumulation, especially globotriaosylceramide (Gb3) and globotriaosylsphingosine (Lyso-Gb3). Enzyme replacement therapy with two recombinant enzymes, agalsidase-α and -β is approved for two different dosages. However, little is known about which enzyme is more effective in decreasing the metabolite load in male and female patients with the classic form of the disease. METHODS In this prospective observational study, 14 consecutive adult Fabry patients (10 males) with a classic GLA-mutation, were switched from agalsidase-α to agalsidase-β at the respective licensed doses. Lyso-Gb3 levels were measured before the switch and for a period of 12 months after the switch in dried blood spots by tandem mass spectrometry. RESULTS Mean age at start of the switch was 36.7 ± 14 years. Plasma Lyso-Gb3 levels decreased from 27.2 ± 17.9 ng/mL before the switch to 16.8 ± 10.5 ng/mL after the switch (mean reduction of 30.1%; p = 0.004). The decrease was maximal in the subgroup of 7 male patients with no or very low residual enzyme activity (mean reduction of 40.4%). However, two females with high residual enzyme activity also showed a reduction >30% after the switch. In male patients, the reduction of plasma Lyso-Gb3 correlated negatively with the residual α-gal A activity: r = -0.803; p = 0.009. CONCLUSION Agalsidase-β at licensed dose is significantly more effective than agalsidase-α to reduce Lyso-Gb3 levels in classic Fabry patients, and should be used as first line therapy in classic males with no residual enzyme activity.
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Affiliation(s)
- Albina Nowak
- Department of Endocrinology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Switzerland; Department of Internal Medicine, Psychiatry University Hospital Zurich, Switzerland.
| | - Olivier Dormond
- Department of Visceral Surgery, Lausanne University Hospital and University of Lausanne, Switzerland.
| | - Véronique Monzambani
- Service of Immunology and Allergy, Lausanne University Hospital and University of Lausanne, Switzerland.
| | - Uyen Huynh-Do
- Department of Nephrology and Hypertension, University Hospital Bern, Switzerland.
| | - Frédéric Barbey
- Service of Immunology and Allergy, Lausanne University Hospital and University of Lausanne, Switzerland.
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Rusu EE, Zilisteanu DS, Ciobotaru LM, Gherghiceanu M, Procop A, Jurcut RO, Dulamea AO, Sorohan BM. The Impact of Kidney Biopsy for Fabry Nephropathy Evaluation on Patients’ Management and Long-Term Outcomes: Experience of a Single Center. Biomedicines 2022; 10:biomedicines10071520. [PMID: 35884826 PMCID: PMC9313342 DOI: 10.3390/biomedicines10071520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Fabry disease (FD) is a rare lysosomal storage disease causing progressive loss of target organ function. All renal cell types are involved from the early stages, even before clinical signs can be detected. FD-specific therapies can stop/mitigate disease progression. Thus, it is important to validate early markers of renal lesions so that they can be adopted as criteria for timely treatment initiation. Materials and methods: We retrospectively analyzed and extensively evaluated 21 FD case patients; this evaluation included a kidney biopsy. We looked for the influence of pathological findings on the management of FD patients. In addition, we investigated the association between general and FD-specific features and long-term patients’ outcomes. We defined a combined endpoint as being at least one of the following: 50% decrease of estimated glomerular filtration rate (eGFR) from baseline, kidney failure (KF), end-stage kidney disease (ESKD), or death and mortality. Results: Our cohort of 21 FD patients (11 males and 10 females) was stratified according to the presence of the combined endpoint: group 1 (n = 15) included patients without the combined endpoint, while group 2 (n = 6) patients reached the combined endpoint outcome. Patients from group 2 presented lower mean baseline eGFR (72.2 ± 38.7 mL/min/1.73 m2 vs. 82.5 ± 26.4 mL/min/1.73 m2) without statistical significance (p = 0.44), but significantly (p = 0.22) higher median baseline proteinuria (2.7 g/24 h vs. 0.4 g/24 h). Specific lysosomal deposits were identified in all patients. Segmental sclerosis was present in all patients with the combined endpoint and in only 33% of patients without the combined endpoint (p = 0.009). Global sclerosis and interstitial fibrosis were present in both groups, with no significant differences. A total of 15 out of the 16 treatment-naïve patients (7 males and 9 females) started FD-specific therapy after kidney biopsy. Treatment was initiated in all male FD patients and in 8 female patients. In 2 females, pathological findings in kidney biopsy offered important reasons to start FD treatment, although specific criteria of the Romanian protocol for prescription of FD-specific therapy were still not fulfilled. Cox univariate analysis showed that every increase in 24 h proteinuria with 1 g is associated with a 65% risk of developing the combined endpoint (HR = 1.65; 95%CI: 1.05–2.58; p = 0.02), and that the presence of segmental sclerosis increased the risk of developing the combined endpoint by 51.3 times (HR = 51.3; 95% CI: 95% CI: 1.67–103.5; p = 0.01). Kaplan–Meier analysis showed that the cumulative risk of developing the combined endpoint was higher in patients in whom segmental sclerosis (100% vs. 0%, log-rank test, p = 0.03) was present. Conclusions: Histological evaluation is an important tool for the detection of early kidney involvement and provides additional support to the early initiation of FD-specific therapy. Presence of segmental sclerosis can predict the long-term outcomes of kidney disease deterioration and mortality and may be used as an early indicator of disease progression. Additionally, in the absence of other criteria according to current guidelines, specific FD renal lesions as revealed by kidney biopsy might become a distinct criterion to initiate FD therapy.
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Affiliation(s)
- Elena-Emanuela Rusu
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.-S.Z.); (L.-M.C.); (M.G.); (R.-O.J.); (A.O.D.); (B.M.S.)
- Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Correspondence:
| | - Diana-Silvia Zilisteanu
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.-S.Z.); (L.-M.C.); (M.G.); (R.-O.J.); (A.O.D.); (B.M.S.)
- Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Lucia-Mihaela Ciobotaru
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.-S.Z.); (L.-M.C.); (M.G.); (R.-O.J.); (A.O.D.); (B.M.S.)
- Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Mihaela Gherghiceanu
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.-S.Z.); (L.-M.C.); (M.G.); (R.-O.J.); (A.O.D.); (B.M.S.)
- “Victor Babes” National Institute for Research and Development in Pathology and Biomedical Sciences, 050097 Bucharest, Romania
| | - Alexandru Procop
- Anatomic Pathology, Fundeni Clinical Institute, 022328 Bucharest, Romania;
| | - Ruxandra-Oana Jurcut
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.-S.Z.); (L.-M.C.); (M.G.); (R.-O.J.); (A.O.D.); (B.M.S.)
- Department of Cardiology, Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, 022328 Bucharest, Romania
| | - Adriana Octaviana Dulamea
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.-S.Z.); (L.-M.C.); (M.G.); (R.-O.J.); (A.O.D.); (B.M.S.)
- Department of Neurology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Bogdan Marian Sorohan
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.-S.Z.); (L.-M.C.); (M.G.); (R.-O.J.); (A.O.D.); (B.M.S.)
- Department of Uronephrology and Kidney Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania
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Welford RW, Farine H, Steiner M, Garzotti M, Dobrenis K, Sievers C, Strasser DS, Amraoui Y, Groenen PM, Giugliani R, Mengel E. Plasma neurofilament light, glial fibrillary acidic protein and lysosphingolipid biomarkers for pharmacodynamics and disease monitoring of GM2 and GM1 gangliosidoses patients. Mol Genet Metab Rep 2022; 30:100843. [PMID: 35242574 PMCID: PMC8856936 DOI: 10.1016/j.ymgmr.2022.100843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 12/03/2022] Open
Abstract
GM2 and GM1 gangliosidoses are genetic, neurodegenerative lysosomal sphingolipid storage disorders. The earlier the age of onset, the more severe the clinical presentation and progression, with infantile, juvenile and late-onset presentations broadly delineated into separate phenotypic subtypes. Gene and substrate reduction therapies, both of which act directly on sphingolipidosis are entering clinical trials for treatment of these disorders. Simple to use biomarkers for disease monitoring are urgently required to support and expedite these clinical trials. Here, lysosphingolipid and protein biomarkers of sphingolipidosis and neuropathology respectively, were assessed in plasma samples from 33 GM2 gangliosidosis patients, 13 GM1 gangliosidosis patients, and compared to 66 controls. LysoGM2 and lysoGM1 were detectable in 31/33 GM2 gangliosidosis and 12/13 GM1 gangliosidosis patient samples respectively, but not in any controls. Levels of the axonal damage marker Neurofilament light (NF-L) were highly elevated in both GM2 and GM1 gangliosidosis patient plasma samples, with no overlap with controls. Levels of the astrocytosis biomarker Glial fibrillary acidic protein (GFAP) were also elevated in samples from both patient populations, albeit with some overlap with controls. In GM2 gangliosidosis patient plasma NF-L, Tau, GFAP and lysoGM2 were all most highly elevated in infantile onset patients, indicating a relationship to severity and phenotype. Plasma NF-L and liver lysoGM2 were also elevated in a GM2 gangliosidosis mouse model, and were lowered by treatment with a drug that slowed disease progression. These results indicate that lysosphingolipids and NF-L/GFAP have potential to monitor pharmacodynamics and pathogenic processes respectively in GM2 and GM1 gangliosidoses patients.
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18
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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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19
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Hughes DA, Aguiar P, Lidove O, Nicholls K, Nowak A, Thomas M, Torra R, Vujkovac B, West ML, Feriozzi S. Do clinical guidelines facilitate or impede drivers of treatment in Fabry disease? Orphanet J Rare Dis 2022; 17:42. [PMID: 35135579 PMCID: PMC8822651 DOI: 10.1186/s13023-022-02181-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background Variable disease progression confounds accurate prognosis in Fabry disease. Evidence supports the long-term benefit of early intervention with disease-specific therapy, but current guidelines recommend treatment initiation based on signs that may present too late to avoid irreversible organ damage. Findings from the ‘PRoposing Early Disease Indicators for Clinical Tracking in Fabry Disease’ (PREDICT-FD) initiative included expert consensus on 27 early indicators of disease progression in Fabry disease and on drivers of and barriers to treatment initiation in Fabry disease. Here, we compared the PREDICT-FD indicators with guidance from the European Fabry Working Group and various national guidelines to identify differences in signs supporting treatment initiation and how guidelines themselves might affect initiation. Finally, anonymized patient histories were reviewed by PREDICT-FD experts to determine whether PREDICT-FD indicators supported earlier treatment than existing guidance. Results Current guidelines generally aligned with PREDICT-FD on indicators of renal involvement, but most lacked specificity regarding cardiac indicators. The prognostic significance of neurological indicators such as white matter lesions (excluded by PREDICT-FD) was questioned in some guidelines and excluded from most. Some PREDICT-FD patient-reported signs (e.g., febrile crises) did not feature elsewhere. Key drivers of treatment initiation in PREDICT-FD were: (A) male sex, young age, and clinical findings (e.g., severe pain, organ involvement), (B) improving clinical outcomes and preventing disease progression, and (C) a family history of Fabry disease (especially if outcomes were severe). All guidelines aligned with (A) and several advocated therapy for asymptomatic male patients. There was scant evidence of (B) in current guidance: for example, no countries mandated ancillary symptomatic therapy, and no guidance advocated familial screening with (C) when diagnosis was confirmed. Barriers were misdiagnosis and a lack of biomarkers to inform timing of treatment. Review of patient histories generally found equal or greater support for treatment initiation with PREDICT-FD indicators than with other guidelines and revealed that the same case and guideline criteria often yielded different treatment recommendations. Conclusions Wider adoption of PREDICT-FD indicators at a national level could promote earlier treatment in Fabry disease. Clearer, more concise guidance is needed to harmonize treatment initiation in Fabry disease internationally. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02181-4.
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Affiliation(s)
- Derralynn A Hughes
- Lysosomal Storage Disorders Unit, Institute of Immunity and Transplantation, Royal Free Hospital, Royal Free London NHS Foundation Trust, Rowland Hill Street, London, NW3 2PF, UK. .,Department of Haematology, University College London, London, UK.
| | - Patrício Aguiar
- Inborn Errors of Metabolism Reference Center, North Lisbon Hospital Center, Lisbon, Portugal.,Medicine Department, Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - Olivier Lidove
- Department of Internal Medicine-Rheumatology, Croix Saint Simon Hospital, Paris, France
| | - Kathleen Nicholls
- Department of Nephrology, Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Medicine, University of Melbourne - Parkville Campus, Parkville, VIC, Australia
| | - Albina Nowak
- Department of Endocrinology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland.,Department of Internal Medicine, Psychiatry University Hospital Zurich, Zurich, Switzerland
| | - Mark Thomas
- Department of Nephrology, Royal Perth Hospital, Perth, WA, Australia
| | - Roser Torra
- Inherited Renal Diseases Unit, Fundacio Puigvert, University Autónoma de Barcelona, Barcelona, Spain
| | - Bojan Vujkovac
- Department of Internal Medicine, General Hospital Slovenj Gradec, Slovenj Gradec, Slovenia
| | - Michael L West
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
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20
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van der Veen SJ, Körver S, Hirsch A, Hollak CEM, Wijburg FA, Brands MM, Tøndel C, van Kuilenburg ABP, Langeveld M. Early start of enzyme replacement therapy in pediatric male patients with classical Fabry disease is associated with attenuated disease progression. Mol Genet Metab 2022; 135:163-169. [PMID: 35033446 DOI: 10.1016/j.ymgme.2021.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/12/2021] [Accepted: 12/13/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Enzyme replacement therapy (ERT) slows disease progression of Fabry disease (FD), especially when initiated before the onset of irreversible organ damage. However, with the clinically asymptomatic progression of renal, cardiac and cerebral disease manifestations spanning decades, optimal timing of ERT initiation remains unclear. METHODS In this cross-sectional retrospective study, seven male FD patients with a classical disease phenotype (cFD) who started treatment with agalsidase-beta in childhood were evaluated after 10 years of treatment (median age at evaluation 24 years, range 14-26). Cardiac imaging (echocardiography and MRI), electrophysiological and biochemical data of these patients were compared to those of untreated male cFD patients (n = 23, median age 22 years, range 13-27). RESULTS Albuminuria was less common and less severe in treated patients (albumin to creatinine ratio, ACR 0-8.8 mg/mmol, median 0.4) compared to untreated patients (ACR 0-248 mg/mmol, median 3.7, p = 0.02). The treated group had a lower left ventricular mass, measured using echocardiography (median 80 g/m2 versus 94 g/m2, p = 0.02) and MRI (median 53 g/m2 versus 68 g/m2, p = 0.02). Myocardial fibrosis was absent in all included patients. eGFR was normal in all treated patients whereas 7/23 (30%) of untreated patients had abnormal eGFR. Cerebral manifestations did not differ. CONCLUSIONS Start of treatment with ERT before age 16, in male cFD patients is associated with reduced occurrence of renal and cardiac manifestations of FD, as assessed by intermediate endpoints. Confirmation that this approach delays or even prevents renal failure and cardiac events requires another decade of follow-up.
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Affiliation(s)
- S J van der Veen
- Amsterdam UMC, University of Amsterdam, Department of Endocrinology and Metabolism, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam Lysosome Center "Sphinx", Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - S Körver
- Amsterdam UMC, University of Amsterdam, Department of Endocrinology and Metabolism, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam Lysosome Center "Sphinx", Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - A Hirsch
- Department of Cardiology and Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Room Rg-419, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - C E M Hollak
- Amsterdam UMC, University of Amsterdam, Department of Endocrinology and Metabolism, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam Lysosome Center "Sphinx", Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - F A Wijburg
- Amsterdam UMC, University of Amsterdam, Department of Pediatric Metabolic Diseases, Emma Children's Hospital, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam Lysosome Center "Sphinx", Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - M M Brands
- Amsterdam UMC, University of Amsterdam, Department of Pediatric Metabolic Diseases, Emma Children's Hospital, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam Lysosome Center "Sphinx", Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - C Tøndel
- Haukeland University Hospital, Department of Paediatrics and University of Bergen, Department of Clinical Medicine, Bergen, Norway
| | - A B P van Kuilenburg
- Amsterdam UMC, University of Amsterdam, Department of Clinical Chemistry, Gastroenterology & Metabolism, Laboratory Genetic Metabolic Diseases, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - M Langeveld
- Amsterdam UMC, University of Amsterdam, Department of Endocrinology and Metabolism, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam Lysosome Center "Sphinx", Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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21
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Chimenz R, Chirico V, Cuppari C, Ceravolo G, Concolino D, Monardo P, Lacquaniti A. Fabry disease and kidney involvement: starting from childhood to understand the future. Pediatr Nephrol 2022; 37:95-103. [PMID: 33928440 DOI: 10.1007/s00467-021-05076-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/15/2021] [Accepted: 03/29/2021] [Indexed: 12/29/2022]
Abstract
The accumulation of globotriaosylceramide (Gb-3) in multiple organs, such as the heart, kidney, and nervous system, due to mutations in the galactosidase alpha (GLA) gene, represents the key point of Fabry disease (FD). The common symptoms appear in childhood or adolescence, including neuropathic pain, angiokeratoma, acroparesthesia, and corneal opacities. A multi-organ involvement induces a significant deterioration in the quality of life with high mortality in adulthood. The accumulation of Gb-3 involves all types of kidney cells beginning at fetal development, many years before clinical manifestations. A decline in the glomerular filtration rate is rare in children, but it can occur during adolescence. Pediatric patients rarely undergo kidney biopsy that could assess the efficacy of enzyme replacement therapy (ERT) behind its diagnostic role. To date, diagnosis is achieved by detecting reduced α-Gal-A activity in leukocytes and plasma, allowing for the early start of ERT. This review focuses on pediatric kidney involvement in FD, analyzing in depth its diagnostic processes and treatment options.
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Affiliation(s)
- Roberto Chimenz
- Pediatric Nephrology and Dialysis Unit, University Hospital "G. Martino", Messina, Italy.
| | - Valeria Chirico
- Unit of Pediatric Emergency, Department of Adult and Childhood Human Pathology, University Hospital of Messina, Messina, Italy
| | - Caterina Cuppari
- Unit of Pediatric Emergency, Department of Adult and Childhood Human Pathology, University Hospital of Messina, Messina, Italy
| | - Giorgia Ceravolo
- Unit of Pediatric Emergency, Department of Adult and Childhood Human Pathology, University Hospital of Messina, Messina, Italy
| | - Daniela Concolino
- Department of Science of Health, Pediatric Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Paolo Monardo
- Nephrology and Dialysis Unit, Papardo Hospital, Messina, Italy
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22
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Germain DP, Levade T, Hachulla E, Knebelmann B, Lacombe D, Seguin VL, Nguyen K, Noël E, Rabès JP. Challenging the traditional approach for interpreting genetic variants: Lessons from Fabry disease. Clin Genet 2021; 101:390-402. [PMID: 34927718 PMCID: PMC9304128 DOI: 10.1111/cge.14102] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 01/14/2023]
Abstract
Fabry disease (FD) is an X-linked genetic disease due to pathogenic variants in GLA. The phenotype varies depending on the GLA variant, alpha-galactosidase residual activity, patient's age and gender and, for females, X chromosome inactivation. Over 1000 variants have been identified, many through screening protocols more susceptible to disclose non-pathogenic variants or variants of unknown significance (VUS). This, together with the non-specificity of some FD symptoms, challenges physicians attempting to interpret GLA variants. The traditional way to interpreting pathogenicity is based on a combined approach using allele frequencies, genomic databases, global and disease-specific clinical databases, and in silico tools proposed by the American College of Medical Genetics and Genomics. Here, a panel of FD specialists convened to study how expertise may compare with the traditional approach. Several GLA VUS, highly controversial in the literature (p.Ser126Gly, p.Ala143Thr, p.Asp313Tyr), were re-analyzed through reviews of patients' charts. The same was done for pathogenic GLA variants with some specificities. Our data suggest that input of geneticists and physicians with wide expertise in disease phenotypes, prevalence, inheritance, biomarkers, alleles frequencies, disease-specific databases, and literature greatly contribute to a more accurate interpretation of the pathogenicity of variants, bringing a significant additional value over the traditional approach.
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Affiliation(s)
- Dominique P Germain
- French Referral Centre for Fabry Disease, Division of Medical Genetics, AP-HP University Paris Saclay, Garches, France.,Division of Medical Genetics, University of Versailles-Saint-Quentin-en-Yvelines, Montigny le Bretonneux, France
| | - Thierry Levade
- INSERM UMR1037, Cancer Research Center of Toulouse (CRCT) and Paul Sabatier University, Toulouse, France.,Clinical Biochemistry Laboratory, Reference Center for Inherited Metabolic Diseases, Federative Institute of Biology, University Hospital of Toulouse, Toulouse, France
| | - Eric Hachulla
- Department of Internal Medicine and Clinical Immunology, Claude Huriez Hospital, University of Lille, Lille, France
| | - Bertrand Knebelmann
- Nephrology-Dialysis Department, AP-HP, Necker Enfants Malades Hospital, University of Paris, Paris, France
| | - Didier Lacombe
- Department of Medical Genetics, University Hospital of Bordeaux, Bordeaux, France.,INSERM U1211, University of Bordeaux, Bordeaux, France
| | - Vanessa Leguy Seguin
- Department of Internal Medicine and Clinical Immunology, François Mitterrand Hospital, Dijon University Hospital, Dijon, France
| | - Karine Nguyen
- Department of Medical Genetics, APHM, Timone Children Hospital, Marseille, France
| | - Esther Noël
- Department of Internal Medicine, Strasbourg University Hospital, Strasbourg, France
| | - Jean-Pierre Rabès
- Division of Medical Genetics, University of Versailles-Saint-Quentin-en-Yvelines, Montigny le Bretonneux, France.,Department of Biochemistry and Molecular Genetics, Ambroise Paré University Hospital, APHP, Paris-Saclay University, Boulogne-Billancourt, France
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23
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Circulating miR-184 is a potential predictive biomarker of cardiac damage in Anderson-Fabry disease. Cell Death Dis 2021; 12:1150. [PMID: 34897278 PMCID: PMC8665928 DOI: 10.1038/s41419-021-04438-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/17/2021] [Accepted: 11/25/2021] [Indexed: 12/20/2022]
Abstract
Enzyme replacement therapy (ERT) is a mainstay of treatment for Anderson-Fabry disease (AFD), a pathology with negative effects on the heart and kidneys. However, no reliable biomarkers are available to monitor its efficacy. Therefore, we tested a panel of four microRNAs linked with cardiac and renal damage in order to identify a novel biomarker associated with AFD and modulated by ERT. To this end, 60 patients with a definite diagnosis of AFD and on chronic ERT, and 29 age- and sex-matched healthy individuals, were enrolled by two Italian university hospitals. Only miR-184 met both conditions: its level discriminated untreated AFD patients from healthy individuals (c-statistic = 0.7522), and it was upregulated upon ERT (P < 0.001). On multivariable analysis, miR-184 was independently and inversely associated with a higher risk of cardiac damage (odds ratio = 0.86; 95% confidence interval [CI] = 0.76-0.98; P = 0.026). Adding miR-184 to a comprehensive clinical model improved the prediction of cardiac damage in terms of global model fit, calibration, discrimination, and classification accuracy (continuous net reclassification improvement = 0.917, P < 0.001; integrated discrimination improvement [IDI] = 0.105, P = 0.017; relative IDI = 0.221, 95% CI = 0.002-0.356). Thus, miR-184 is a circulating biomarker of AFD that changes after ERT. Assessment of its level in plasma could be clinically valuable in improving the prediction of cardiac damage in AFD patients.
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24
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Rubino M, Monda E, Lioncino M, Caiazza M, Palmiero G, Dongiglio F, Fusco A, Cirillo A, Cesaro A, Capodicasa L, Mazzella M, Chiosi F, Orabona P, Bossone E, Calabrò P, Pisani A, Germain DP, Biagini E, Pieroni M, Limongelli G. Diagnosis and Management of Cardiovascular Involvement in Fabry Disease. Heart Fail Clin 2021; 18:39-49. [PMID: 34776082 DOI: 10.1016/j.hfc.2021.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Fabry disease (FD, OMIM 301500) is an X-linked lysosomal storage disease caused by pathogenic variants in the GLA gene. Cardiac involvement is common in FD and is responsible for impaired quality of life and premature death. The classic cardiac involvement is a nonobstructive form of hypertrophic cardiomyopathy, usually manifesting as concentric left ventricular hypertrophy, with subsequent arrhythmogenic intramural fibrosis. Treatment of patients with FD should be directed to prevent the disease progression to irreversible organ damage and organ failure. The aim of this review is to describe the current state of knowledge regarding cardiovascular involvement in FD, focusing on clinical and instrumental features, cardiovascular management, and targeted therapy.
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Affiliation(s)
- Marta Rubino
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Emanuele Monda
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Michele Lioncino
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Martina Caiazza
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Giuseppe Palmiero
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Francesca Dongiglio
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Adelaide Fusco
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Annapaola Cirillo
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Laura Capodicasa
- Department of Nephrology, Monaldi Hospital, Via L. Bianchi, Naples 80131, Italy
| | - Marialuisa Mazzella
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Flavia Chiosi
- Department of Ophthalmology, Monaldi Hospital, Via L. Bianchi, Naples 80131, Italy
| | - Paolo Orabona
- Department of Ophthalmology, Monaldi Hospital, Via L. Bianchi, Naples 80131, Italy
| | - Eduardo Bossone
- Division of Cardiology, Antonio Cardarelli Hospital, Via A. Cardarelli, Naples 80131, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Antonio Pisani
- Department of Public Health, University Federico II of Naples, Via Pansini, Naples 80131, Italy
| | - Dominique P Germain
- French Referral Centre for Fabry Disease, Division of Medical Genetics, Hôpital Raymond-Poincare, AP-HP, Garches 92380, France
| | - Elena Biagini
- Cardiology Unit, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | - Giuseppe Limongelli
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy; Institute of Cardiovascular Sciences, University College of London and St. Bartholomew's Hospital, Grower Street, London WC1E 6DD, UK.
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25
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Lenders M, Brand E. Mechanisms of Neutralizing Anti-drug Antibody Formation and Clinical Relevance on Therapeutic Efficacy of Enzyme Replacement Therapies in Fabry Disease. Drugs 2021; 81:1969-1981. [PMID: 34748189 PMCID: PMC8602155 DOI: 10.1007/s40265-021-01621-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 12/13/2022]
Abstract
Fabry disease (FD) is a rare X-linked lysosomal storage disorder caused by mutations in the α-galactosidase A (AGAL/GLA) gene. The lysosomal accumulation of the substrates globotriaosylceramide (Gb3) and globotriaosylsphingosine (lyso-Gb3) results in progressive renal failure, cardiomyopathy associated with cardiac arrhythmia, and recurrent strokes, significantly limiting life expectancy in affected patients. Current treatment options for FD include recombinant enzyme-replacement therapies (ERTs) with intravenous agalsidase-α (0.2 mg/kg body weight) or agalsidase-β (1 mg/kg body weight) every 2 weeks, facilitating cellular Gb3 clearance and an overall improvement of disease burden. However, ERT can lead to infusion-associated reactions, as well as the formation of neutralizing anti-drug antibodies (ADAs) in ERT-treated males, leading to an attenuation of therapy efficacy and thus disease progression. In this narrative review, we provide a brief overview of the clinical picture of FD and diagnostic confirmation. The focus is on the biochemical and clinical significance of neutralizing ADAs as a humoral response to ERT. In addition, we provide an overview of different methods for ADA measurement and characterization, as well as potential therapeutic approaches to prevent or eliminate ADAs in affected patients, which is representative for other ERT-treated lysosomal storage diseases.
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Affiliation(s)
- Malte Lenders
- Department of Internal Medicine D, Nephrology, Hypertension and Rheumatology, Interdisciplinary Fabry Center Münster (IFAZ), University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
| | - Eva Brand
- Department of Internal Medicine D, Nephrology, Hypertension and Rheumatology, Interdisciplinary Fabry Center Münster (IFAZ), University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
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26
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Goicoechea M, Gomez-Preciado F, Benito S, Torras J, Torra R, Huerta A, Restrepo A, Ugalde J, Astudillo DE, Agraz I, Lopez-Mendoza M, de Arriba G, Corchete E, Quiroga B, Gutierrez MJ, Martin-Conde ML, Lopes V, Ramos C, Mendez I, Cao M, Dominguez F, Ortiz A. Predictors of outcome in a Spanish cohort of patients with Fabry disease on enzyme replacement therapy. Nefrologia 2021; 41:652-660. [PMID: 36165155 DOI: 10.1016/j.nefroe.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/18/2021] [Indexed: 06/16/2023] Open
Abstract
UNLABELLED Fabry disease may be treated by enzyme replacement therapy (ERT), but the impact of chronic kidney disease (CKD) on the response to therapy remains unclear. The aim of the present study was to analyse the incidence and predictors of clinical events in patients on ERT. STUDY DESIGN Multicentre retrospective observational analysis of patients diagnosed and treated with ERT for Fabry disease. The primary outcome was the first renal, neurological or cardiological events or death during a follow-up of 60 months (24-120). RESULTS In 69 patients (42 males, 27 females, mean age 44.6±13.7 years), at the end of follow-up, eGFR and the left ventricular septum thickness remained stable and the urinary albumin: creatinine ratio tended to decrease, but this decrease only approached significance in patients on agalsidase-beta (242-128mg/g (p=0.05). At the end of follow-up, 21 (30%) patients had suffered an incident clinical event: 6 renal, 2 neurological and 13 cardiological (including 3 deaths). Events were more frequent in patients with baseline eGFR≤60ml/min/1.73m2 (log Rank 12.423, p=0.001), and this remained significant even after excluding incident renal events (log Rank 4.086, p=0.043) and in males and in females. Lower baseline eGFR was associated with a 3- to 7-fold increase the risk of clinical events in different Cox models. CONCLUSIONS GFR at the initiation of ERT is the main predictor of clinical events, both in males and in females, suggesting that start of ERT prior to the development of CKD is associated with better outcomes.
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Affiliation(s)
- Marian Goicoechea
- Servicio de Nefrología Hospital General Universitario Gregorio Marañon, Spain; Red de Investigación Renal (REDinRen), Fondos FEDER, Spain.
| | | | | | - Joan Torras
- Red de Investigación Renal (REDinRen), Fondos FEDER, Spain; Servicio de Nefrología Hospital Universitario de Bellvitge, Spain
| | - Roser Torra
- Red de Investigación Renal (REDinRen), Fondos FEDER, Spain; Servicio de Nefrología Fundacion Puigvert, Spain
| | - Ana Huerta
- Servicio de Nefrología Hospital Universitario Puerta del Hierro Majadahonda, Spain
| | | | - Jessica Ugalde
- Servicio de Nefrología Hospital Clinic de Barcelona, Spain
| | | | - Irene Agraz
- Servicio de Nefrología Hospital Vall d'Hebron, Spain
| | | | - Gabriel de Arriba
- Servicio de Nefrología Hospital General Universitario de Guadalajara, Universidad de Alcalá de Henares, Spain
| | | | - Borja Quiroga
- Servicio de Nefrología Hospital Universitario de la Princesa, Spain
| | | | | | - Vanessa Lopes
- Servicio de Nefrología del Hospital Universitario Ramon y Cajal, Spain
| | - Carmela Ramos
- Servicio de Nefrología del Hospital Clínico Universitario de Valencia, Spain
| | - Irene Mendez
- Servicio de Cardiología del Hospital General Universitario Gregorio Marañon, Spain
| | - Mercedes Cao
- Servicio de Nefrología Complexo Hospitalario Universitario A Coruña, Spain
| | | | - Alberto Ortiz
- Red de Investigación Renal (REDinRen), Fondos FEDER, Spain; Servicio de Nefrología de la Fundación Jimenez Diaz, Spain
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Hughes D, Linhart A, Gurevich A, Kalampoki V, Jazukeviciene D, Feriozzi S. Prompt Agalsidase Alfa Therapy Initiation is Associated with Improved Renal and Cardiovascular Outcomes in a Fabry Outcome Survey Analysis. Drug Des Devel Ther 2021; 15:3561-3572. [PMID: 34429585 PMCID: PMC8379390 DOI: 10.2147/dddt.s313789] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/28/2021] [Indexed: 12/30/2022] Open
Abstract
Background The timing of enzyme replacement therapy initiation in patients with Fabry disease is hypothesized to be critical. In this study, we used Fabry Outcome Survey data to assess the impact of prompt versus delayed initiation of treatment with agalsidase alfa on cardiovascular and renal events in patients with Fabry disease. Methods Available genetic data at baseline were used to define patients with mutations associated with classical versus late-onset Fabry disease. Time to cardiovascular or renal events, from treatment initiation until 120 months, was compared for patients in prompt versus delayed groups. "Prompt" was defined as treatment initiation <24 months from symptom onset (analysis A) or diagnosis (analysis B), and "delayed" was defined as ≥24 months from symptom onset (analysis A) or diagnosis (analysis B). Kaplan-Meier curves and Log rank tests compared event-free probabilities and time to first event. Multivariate Cox regression estimated hazard ratios (HRs). Results Analysis by time from symptom onset included 1374 patients (172 prompt, 1202 delayed). In a multivariate Cox regression analysis, prompt versus delayed treatment initiation significantly reduced the probability of cardiovascular (HR=0.62; P<0.001) and renal (HR=0.57; P=0.001) events. History of cardiovascular or renal events was associated with increased risk of respective events. Analysis by time from diagnosis included 2051 patients (1006 prompt, 1045 delayed). In a multivariate Cox regression analysis, prompt treatment initiation significantly reduced the probability of cardiovascular events (HR=0.83; P=0.003) after adjusting for history of cardiovascular events, sex, and age at treatment initiation. Univariate analysis showed that the probability of renal events was significantly lower in the prompt group (P=0.018); this finding was attenuated in the multivariate Cox regression analysis. Conclusion This analysis suggests that prompt treatment initiation with agalsidase alfa provided better renal and cardiovascular outcomes than delayed treatment in patients with Fabry disease.
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Affiliation(s)
- Derralynn Hughes
- University College London and Royal Free London NHS Foundation Trust, London, UK
| | - Aleš Linhart
- Charles University, First Faculty of Medicine, Prague, Czech Republic
| | - Andrey Gurevich
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | | | | | - Sandro Feriozzi
- Nephrology and Dialysis Unit, Belcolle Hospital, Department of Nephrology and Dialysis, Viterbo, Italy
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Viggiano E, Politano L. X Chromosome Inactivation in Carriers of Fabry Disease: Review and Meta-Analysis. Int J Mol Sci 2021; 22:ijms22147663. [PMID: 34299283 PMCID: PMC8304911 DOI: 10.3390/ijms22147663] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 12/27/2022] Open
Abstract
Anderson-Fabry disease is an X-linked inborn error of glycosphingolipid catabolism caused by a deficiency of α-galactosidase A. The incidence ranges between 1: 40,000 and 1:117,000 of live male births. In Italy, an estimate of incidence is available only for the north-western Italy, where it is of approximately 1:4000. Clinical symptoms include angiokeratomas, corneal dystrophy, and neurological, cardiac and kidney involvement. The prevalence of symptomatic female carriers is about 70%, and in some cases, they can exhibit a severe phenotype. Previous studies suggest a correlation between skewed X chromosome inactivation and symptoms in carriers of X-linked disease, including Fabry disease. In this review, we briefly summarize the disease, focusing on the clinical symptoms of carriers and analysis of the studies so far published in regards to X chromosome inactivation pattern, and manifesting Fabry carriers. Out of 151 records identified, only five reported the correlation between the analysis of XCI in leukocytes and the related phenotype in Fabry carriers, in particular evaluating the Mainz Severity Score Index or cardiac involvement. The meta-analysis did not show any correlation between MSSI or cardiac involvement and skewed XCI, likely because the analysis of XCI in leukocytes is not useful for predicting the phenotype in Fabry carriers.
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Affiliation(s)
- Emanuela Viggiano
- Department of Prevention, UOC Hygiene Service and Public Health, ASL Roma 2, 00142 Rome, Italy
- Correspondence: (E.V.); (L.P.)
| | - Luisa Politano
- Cardiomyology and Medical Genetics, Department of Experimental Medicine, Luigi Vanvitelli University, 80138 Naples, Italy
- Correspondence: (E.V.); (L.P.)
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Oder D, Müntze J, Nordbeck P. Contemporary therapeutics and new drug developments for treatment of Fabry disease: a narrative review. Cardiovasc Diagn Ther 2021; 11:683-695. [PMID: 33968645 DOI: 10.21037/cdt-20-743] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Fabry disease (OMIM 301500) is an X-linked (Xq22.1) lysosomal storage disorder leading to a progressive multisystem disease with high variability in both genotype and phenotype expression. The pathophysiological origin is found in an enzyme deficiency of the α-galactosidase A (enzyme commission no. 3.2.1.22) leading to accumulation of globotriaosylceramides in all lysosome carrying tissue. Especially organ manifestations of the heart, kidneys and nervous system are of significant prognostic value and might complicate with Fabry-associated pain, young aged cryptogenic stroke, proteinuria, kidney failure, hypertrophic cardiomyopathy, heart failure, malign cardiac rhythm disturbances and eventually sudden cardiac death. Up to the introduction of the first enzyme replacement agent in 2001, patients faced the disease's natural course with no disease-specific therapies available. Today, two recombinant enzyme replacement agents (Fabrazyme®, Sanofi Genzyme, Cambridge, MA, USA; Replagal®, Takeda Pharmaceutical, Tokio, Japan) and one oral chaperone therapy (Migalastat®, Amicus Therapeutics, USA) are available and well-established in daily clinical practice. Substrate reduction therapy, second-generation enzyme replacement agents and different gene therapy approaches are currently undergoing preclinical and clinical trial phases and aim to improve therapeutic success and long-term outcome of patients with Fabry disease. This narrative review summarizes the currently available therapeutic options and future perspectives in Fabry disease.
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Affiliation(s)
- Daniel Oder
- Department of Internal Medicine I, Fabry Center for Interdisciplinary Therapy (FAZIT) and Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Würzburg, Germany
| | - Jonas Müntze
- Department of Internal Medicine I, Fabry Center for Interdisciplinary Therapy (FAZIT) and Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Würzburg, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, Fabry Center for Interdisciplinary Therapy (FAZIT) and Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Würzburg, Germany
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Goicoechea M, Gomez-Preciado F, Benito S, Torras J, Torra R, Huerta A, Restrepo A, Ugalde J, Astudillo DE, Agraz I, Lopez-Mendoza M, de Arriba G, Corchete E, Quiroga B, Gutierrez MJ, Martin-Conde ML, Lopes V, Ramos C, Mendez I, Cao M, Dominguez F, Ortiz A. Predictors of outcome in a Spanish cohort of patients with Fabry disease on enzyme replacement therapy. Nefrologia 2021; 41:S0211-6995(21)00031-X. [PMID: 33714629 DOI: 10.1016/j.nefro.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 11/21/2022] Open
Abstract
Fabry disease may be treated by enzyme replacement therapy (ERT), but the impact of chronic kidney disease (CKD) on the response to therapy remains unclear. The aim of the present study was to analyse the incidence and predictors of clinical events in patients on ERT. STUDY DESIGN Multicentre retrospective observational analysis of patients diagnosed and treated with ERT for Fabry disease. The primary outcome was the first renal, neurological or cardiological events or death during a follow-up of 60 months (24-120). RESULTS In 69 patients (42 males, 27 females, mean age 44.6±13.7 years), at the end of follow-up, eGFR and the left ventricular septum thickness remained stable and the urinary albumin: creatinine ratio tended to decrease, but this decrease only approached significance in patients on agalsidase-beta (242-128mg/g (p=0.05). At the end of follow-up, 21 (30%) patients had suffered an incident clinical event: 6 renal, 2 neurological and 13 cardiological (including 3 deaths). Events were more frequent in patients with baseline eGFR≤60ml/min/1.73m2 (log Rank 12.423, p=0.001), and this remained significant even after excluding incident renal events (log Rank 4.086, p=0.043) and in males and in females. Lower baseline eGFR was associated with a 3- to 7-fold increase the risk of clinical events in different Cox models. CONCLUSIONS GFR at the initiation of ERT is the main predictor of clinical events, both in males and in females, suggesting that start of ERT prior to the development of CKD is associated with better outcomes.
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Affiliation(s)
- Marian Goicoechea
- Servicio de Nefrología Hospital General Universitario Gregorio Marañon, Spain; Red de Investigación Renal (REDinRen), Fondos FEDER, Spain.
| | | | | | - Joan Torras
- Red de Investigación Renal (REDinRen), Fondos FEDER, Spain; Servicio de Nefrología Hospital Universitario de Bellvitge, Spain
| | - Roser Torra
- Red de Investigación Renal (REDinRen), Fondos FEDER, Spain; Servicio de Nefrología Fundacion Puigvert, Spain
| | - Ana Huerta
- Servicio de Nefrología Hospital Universitario Puerta del Hierro Majadahonda, Spain
| | | | - Jessica Ugalde
- Servicio de Nefrología Hospital Clinic de Barcelona, Spain
| | | | - Irene Agraz
- Servicio de Nefrología Hospital Vall d'Hebron, Spain
| | | | - Gabriel de Arriba
- Servicio de Nefrología Hospital General Universitario de Guadalajara, Universidad de Alcalá de Henares, Spain
| | | | - Borja Quiroga
- Servicio de Nefrología Hospital Universitario de la Princesa, Spain
| | | | | | - Vanessa Lopes
- Servicio de Nefrología del Hospital Universitario Ramon y Cajal, Spain
| | - Carmela Ramos
- Servicio de Nefrología del Hospital Clínico Universitario de Valencia, Spain
| | - Irene Mendez
- Servicio de Cardiología del Hospital General Universitario Gregorio Marañon, Spain
| | - Mercedes Cao
- Servicio de Nefrología Complexo Hospitalario Universitario A Coruña, Spain
| | | | - Alberto Ortiz
- Red de Investigación Renal (REDinRen), Fondos FEDER, Spain; Servicio de Nefrología de la Fundación Jimenez Diaz, Spain
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Nowak A, Beuschlein F, Sivasubramaniam V, Kasper D, Warnock DG. Lyso-Gb3 associates with adverse long-term outcome in patients with Fabry disease. J Med Genet 2021; 59:287-293. [PMID: 33495303 PMCID: PMC8867289 DOI: 10.1136/jmedgenet-2020-107338] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/06/2020] [Accepted: 12/03/2020] [Indexed: 12/26/2022]
Abstract
Background Fabry disease (FD) is a rare X-linked lysosomal storage disease caused by mutations in the α-galactosidase A gene (GLA) leading to deficiency of α-galactosidase A and ultimately in progressive glycosphingolipid accumulation, especially globotriaosylceramide (Gb3) and its deacylated derivative globotriaosylsphingosine (Lyso-Gb3). The aim of the study was to assess plasma Lyso-Gb3 levels as a possible factor associated with adverse outcomes in FD. Methods In a cohort of 66 patients with genetically confirmed FD (26 males and 40 females), we analysed serum Lyso-Gb3 as a factor associated with adverse clinical outcomes in a long-term study. The main outcome was a composite endpoint of incident kidney replacement therapy, atrial fibrillation, pacemaker and/or implantable cardioverter defibrillator, cerebrovascular events or death, whichever occurred first. Results During the median follow-up time of 68 (40–80) months, events occurred in 19 (29%) of the patients. In a Cox multivariate regression analysis, Lyso-Gb3 levels (HR 4.62 (1.55 to 13.81); p=0.006) and the pretreatment exposure to Lyso-Gb3 (HR 3.41 (1.11 to 10.49); p=0.03) (both per SD increase) were significantly associated with adverse outcomes. If pretreatment Lyso-Gb3 exposure was added to multivariable logistic regression models containing age, sex, phenotype and enzyme replacement therapy as other covariates with the composite outcome as dependent variable, the area under the curve for the composite outcome significantly improved from 0.72 to 0.86 (p comparison=0.04). Conclusion Lyso-Gb3 is a significant risk factor associated with important clinical events. Whether treatment-related amelioration of Lyso-Gb3 levels will be associated with improved long-term outcome needs to be established in prospective intervention trials.
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Affiliation(s)
- Albina Nowak
- Department of Endocrinology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
- Division of Internal Medicine, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Felix Beuschlein
- Department of Endocrinology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
| | - Visnuka Sivasubramaniam
- Department of Endocrinology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
| | | | - David G Warnock
- Department of Medicine, Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Variable clinical features of patients with Fabry disease and outcome of enzyme replacement therapy. Mol Genet Metab Rep 2020; 26:100700. [PMID: 33437642 PMCID: PMC7788237 DOI: 10.1016/j.ymgmr.2020.100700] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/22/2020] [Accepted: 12/22/2020] [Indexed: 12/29/2022] Open
Abstract
Fabry disease (FD) is an X-linked lysosomal storage disorder caused by a deficiency in the enzyme α-galactosidase A due to mutations in the GLA gene. This leads to an accumulation of globotriaosylceramide (GL-3) in many tissues, which results in progressive damage to the kidneys, heart, and nervous system. We present the molecular and clinical characteristics and long-term outcomes of FD patients from a multidisciplinary clinic at the University of California, Irvine treated with agalsidase beta enzyme replacement therapy (ERT) for 2-20 years. This cohort comprised 24 adults (11 males, 13 females) and two male children (median age 45; range 10-68 years). Of the 26 patients in this cohort, 20 were on ERT (12 males, 8 females). We describe one novel variant not previously reported in the literature in a patient with features of 'classic' FD. The vast majority of patients in this cohort presented with symptoms of 'classic' FD including peripheral neuropathic pain, some form of cardiac involvement, angiokeratomas, corneal verticillata, hypohidrosis, tinnitus, and gastrointestinal symptoms, primarily abdominal pain. The majority of males had clinically evident renal involvement. An annual eGFR reduction of -1.88 mL/min/1.73 m2/yr during the course of ERT was seen in this cohort. The most common renal presentation was proteinuria, and one individual required a renal transplant. Other common findings were pulmonary involvement, lymphedema, hearing loss, and significantly, three patients had strokes. Notably, there was a high prevalence of endocrine dysfunction and low bone mineral density, including several with osteoporosis. While enzyme replacement therapy (ERT) cleared plasma GL-3 in this cohort, there was limited improvement in renal function or health-related quality of life based on the patient-reported SF-36 Health Survey. Physical functioning significantly declined over the course of ERT treatment, which may be, in part, due to the late initiation of ERT in several patients. Further delineation of the phenotypic and genotypic spectrum in patients with FD and the long-term outcome of ERT will help improve management and treatment options for this disease.
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Azevedo O, Gago MF, Miltenberger-Miltenyi G, Sousa N, Cunha D. Fabry Disease Therapy: State-of-the-Art and Current Challenges. Int J Mol Sci 2020; 22:ijms22010206. [PMID: 33379210 PMCID: PMC7794923 DOI: 10.3390/ijms22010206] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 12/13/2022] Open
Abstract
Fabry disease (FD) is a lysosomal storage disorder caused by mutations of the GLA gene that lead to a deficiency of the enzymatic activity of α-galactosidase A. Available therapies for FD include enzyme replacement therapy (ERT) (agalsidase alfa and agalsidase beta) and the chaperone migalastat. Despite the large body of literature published about ERT over the years, many issues remain unresolved, such as the optimal dose, the best timing to start therapy, and the clinical impact of anti-drug antibodies. Migalastat was recently approved for FD patients with amenable GLA mutations; however, recent studies have raised concerns that "in vitro" amenability may not always reflect "in vivo" amenability, and some findings on real-life studies have contrasted with the results of the pivotal clinical trials. Moreover, both FD specific therapies present limitations, and the attempt to correct the enzymatic deficiency, either by enzyme exogenous administration or enzyme stabilization with a chaperone, has not shown to be able to fully revert FD pathology and clinical manifestations. Therefore, several new therapies are under research, including new forms of ERT, substrate reduction therapy, mRNA therapy, and gene therapy. In this review, we provide an overview of the state-of-the-art on the currently approved and emerging new therapies for adult patients with FD.
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Affiliation(s)
- Olga Azevedo
- Cardiology Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (M.F.G.); (G.M.-M.); (N.S.); (D.C.)
- ICVS/3Bs PT Government Associate Laboratory, 4805-017 Braga/Guimarães, Portugal
- Correspondence: ; Tel.: +351-253-540-330; Fax: +351-253-513-592
| | - Miguel Fernandes Gago
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (M.F.G.); (G.M.-M.); (N.S.); (D.C.)
- ICVS/3Bs PT Government Associate Laboratory, 4805-017 Braga/Guimarães, Portugal
- Neurology Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - Gabriel Miltenberger-Miltenyi
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (M.F.G.); (G.M.-M.); (N.S.); (D.C.)
- ICVS/3Bs PT Government Associate Laboratory, 4805-017 Braga/Guimarães, Portugal
- Genetics Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (M.F.G.); (G.M.-M.); (N.S.); (D.C.)
- ICVS/3Bs PT Government Associate Laboratory, 4805-017 Braga/Guimarães, Portugal
| | - Damião Cunha
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (M.F.G.); (G.M.-M.); (N.S.); (D.C.)
- ICVS/3Bs PT Government Associate Laboratory, 4805-017 Braga/Guimarães, Portugal
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Hughes DA, Aguiar P, Deegan PB, Ezgu F, Frustaci A, Lidove O, Linhart A, Lubanda JC, Moon JC, Nicholls K, Niu DM, Nowak A, Ramaswami U, Reisin R, Rozenfeld P, Schiffmann R, Svarstad E, Thomas M, Torra R, Vujkovac B, Warnock DG, West ML, Johnson J, Rolfe MJ, Feriozzi S. Early indicators of disease progression in Fabry disease that may indicate the need for disease-specific treatment initiation: findings from the opinion-based PREDICT-FD modified Delphi consensus initiative. BMJ Open 2020; 10:e035182. [PMID: 33039984 PMCID: PMC7549469 DOI: 10.1136/bmjopen-2019-035182] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The PRoposing Early Disease Indicators for Clinical Tracking in Fabry Disease (PREDICT-FD) initiative aimed to reach consensus among a panel of global experts on early indicators of disease progression that may justify FD-specific treatment initiation. DESIGN AND SETTING Anonymous feedback from panellists via online questionnaires was analysed using a modified Delphi consensus technique. Questionnaires and data were managed by an independent administrator directed by two non-voting cochairs. First, possible early indicators of renal, cardiac and central/peripheral nervous system (CNS/PNS) damage, and other disease and patient-reported indicators assessable in routine clinical practice were compiled by the cochairs and administrator from panellists' free-text responses. Second, the panel scored indicators for importance (5-point scale: 1=not important; 5=extremely important); indicators scoring ≥3 among >75% of panellists were then rated for agreement (5-point scale: 1=strongly disagree; 5=strongly agree). Indicators awarded an agreement score ≥4 by >67% of panellists achieved consensus. Finally, any panel-proposed refinements to consensus indicator definitions were adopted if >75% of panellists agreed. RESULTS A panel of 21 expert clinicians from 15 countries provided information from which 83 possible current indicators of damage (kidney, 15; cardiac, 15; CNS/PNS, 13; other, 16; patient reported, 24) were compiled. Of 45 indicators meeting the importance criteria, consensus was reached for 29 and consolidated as 27 indicators (kidney, 6; cardiac, 10; CNS/PNS, 2; other, 6; patient reported, 3) including: (kidney) elevated albumin:creatinine ratio, histological damage, microalbuminuria; (cardiac) markers of early systolic/diastolic dysfunction, elevated serum cardiac troponin; (CNS/PNS) neuropathic pain, gastrointestinal symptoms suggestive of gastrointestinal neuropathy; (other) pain in extremities/neuropathy, angiokeratoma; (patient-reported) febrile crises, progression of symptoms/signs. Panellists revised and approved proposed chronologies of when the consensus indicators manifest. The panel response rate was >95% at all stages. CONCLUSIONS PREDICT-FD captured global opinion regarding current clinical indicators that could prompt FD-specific treatment initiation earlier than is currently practised.
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Affiliation(s)
- Derralynn A Hughes
- Lysosomal Storage Disorders Unit, Royal Free Hospital, London, UK
- Department of Haematology, University College London, London, UK
| | - Patricio Aguiar
- Inborn Errors of Metabolism Reference Center, North Lisbon Hospital Center, Lisbon, Portugal
- Medicine Department, University of Lisbon, Lisbon, Portugal
| | - Patrick B Deegan
- Lysosomal Disorders Unit, Addenbrooke's Hospital, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Fatih Ezgu
- Department and Laboratory of Paediatric Metabolic Disorders, Gazi University, Ankara, Turkey
| | - Andrea Frustaci
- Department of Cardiovascular, Respiratory, Nephrologic, Geriatric and Anesthesiologic Sciences, University of Rome La Sapienza, Rome, Italy
| | - Olivier Lidove
- Department of Internal Medicine-Rheumatology, Croix Saint Simon Hospital, Paris, France
| | - Aleš Linhart
- Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jean-Claude Lubanda
- Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - James C Moon
- Cardiac Imaging Department, Barts Heart Centre, London, UK
| | - Kathleen Nicholls
- Department of Nephrology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia
| | - Dau-Ming Niu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Albina Nowak
- Department of Endocrinology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Department of Internal Medicine, Psychiatry University Hospital Zurich, Zurich, Switzerland
| | - Uma Ramaswami
- Lysosomal Storage Disorders Unit, Royal Free Hospital, London, UK
| | - Ricardo Reisin
- Department of Neurology, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Paula Rozenfeld
- Instituto de Estudios Inmunológicos y Fisiopatológicos, UNLP - CONICET, La Plata, Argentina
| | - Raphael Schiffmann
- Institute of Metabolic Disease, Baylor Research Institute, Dallas, Texas, USA
| | - Einar Svarstad
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Mark Thomas
- Department of Nephrology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Roser Torra
- Inherited Renal Diseases Unit, Autonomous University of Barcelona, Barcelona, Spain
| | - Bojan Vujkovac
- Department of Internal Medicine, General Hospital Slovenj Gradec, Slovenj Gradec, Slovenia
| | - David G Warnock
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael L West
- Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jack Johnson
- Fabry Support & Information Group, Concordia, Missouri, USA
- Fabry International Network, Beveren, Belgium
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Kant S, Atta MG. Therapeutic advances in Fabry disease: The future awaits. Biomed Pharmacother 2020; 131:110779. [PMID: 33152937 DOI: 10.1016/j.biopha.2020.110779] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/12/2020] [Accepted: 09/17/2020] [Indexed: 02/02/2023] Open
Abstract
Fabry disease (FD) is an X-linked disorder caused by mutations in GLA gene responsible for coding of the lysosomal enzyme alpha-galactosidase A(α-GAL). The resultant accumulation of globotriaosylceramide (Gb-3) leads to multisystemic disease including progressive chronic kidney disease, hypertrophic cardiomyopathy, stroke, angiokeratomas and corneal whorls. Current treatments include enzyme replacement therapy (ERT), along with recent advent of chaperone therapy. ERT has not shown to have dramatic improvement in outcomes for all organ systems, with benefit mostly seen in kidney disease and reduction in left ventricular hypertrophy. ERT, however, is associated with formation of anti-drug antibodies and requirement of long-term venous access, while chaperone therapy can only be used in amenable mutations. A multitude of therapies are now under investigation in various phases of clinical trials. These include pegylated form of α-GAL (pegunigalsidase alpha), gene therapy (both in-vivo and ex-vivo methods), mRNA therapy (inducing production of α-GAL) and substrate reduction therapy (inhibitors of glucosylceramide synthase leading to reduction of Gb-3). This review encapsulates literature pertaining to current and investigational therapies for FD.
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Affiliation(s)
- Sam Kant
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mohamed G Atta
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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van der Veen SJ, Hollak CEM, van Kuilenburg ABP, Langeveld M. Developments in the treatment of Fabry disease. J Inherit Metab Dis 2020; 43:908-921. [PMID: 32083331 PMCID: PMC7540041 DOI: 10.1002/jimd.12228] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 02/10/2020] [Accepted: 02/17/2020] [Indexed: 12/19/2022]
Abstract
Enzyme replacement therapy (ERT) with recombinant α-galactosidase A (r-αGAL A) for the treatment of Fabry disease has been available for over 15 years. Long-term treatment may slow down disease progression, but cardiac, renal, and cerebral complications still develop in most patients. In addition, lifelong intravenous treatment is burdensome. Therefore, several new treatment approaches have been explored over the past decade. Chaperone therapy (Migalastat; 1-deoxygalactonojirimycin) is the only other currently approved therapy for Fabry disease. This oral small molecule aims to improve enzyme activity of mutated α-galactosidase A and can only be used in patients with specific mutations. Treatments currently under evaluation in (pre)clinical trials are second generation enzyme replacement therapies (Pegunigalsidase-alfa, Moss-aGal), substrate reduction therapies (Venglustat and Lucerastat), mRNA- and gene-based therapy. This review summarises the knowledge on currently available and potential future options for the treatment of Fabry disease.
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Affiliation(s)
- Sanne J. van der Veen
- Department of Endocrinology and MetabolismAmsterdam UMC, University of AmsterdamAZAmsterdamThe Netherlands
| | - Carla E. M. Hollak
- Department of Endocrinology and MetabolismAmsterdam UMC, University of AmsterdamAZAmsterdamThe Netherlands
| | - André B. P. van Kuilenburg
- Department of Clinical Chemistry, Gastroenterology & MetabolismAmsterdam UMC, University of AmsterdamAZAmsterdamThe Netherlands
| | - Mirjam Langeveld
- Department of Endocrinology and MetabolismAmsterdam UMC, University of AmsterdamAZAmsterdamThe Netherlands
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Ortiz A, Kanters S, Hamed A, DasMahapatra P, Poggio E, Maski M, Aguiar M, Ponce E, Jansen JP, Ayers D, Goldgrub R, Desnick RJ. Agalsidase beta treatment slows estimated glomerular filtration rate loss in classic Fabry disease patients: results from an individual patient data meta-analysis. Clin Kidney J 2020; 14:1136-1146. [PMID: 33841859 PMCID: PMC8023189 DOI: 10.1093/ckj/sfaa065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 03/26/2020] [Indexed: 01/07/2023] Open
Abstract
Background Fabry disease is a rare, X-linked genetic disorder that, if untreated in patients with the Classic phenotype, often progresses to end-stage kidney disease. This meta-analysis determined the effect of agalsidase beta on loss of estimated glomerular filtration rate (eGFR) in the Classic phenotype using an expansive evidence base of individual patient-level data. Methods The evidence base included four Sanofi-Genzyme studies and six studies from a systematic literature review. These were restricted to Classic Fabry patients meeting the eligibility criteria from Phases III and IV agalsidase beta trials, including 315 patients (161 treated). Linear regression was first used to model annual change in eGFR for each patient and the resulting annualized eGFR slopes were modelled with treatment and covariates using quantile regression. These results were then used to estimate median annualized eGFR change in agalsidase beta treated versus untreated groups. Results Imbalances across treatment groups were found in baseline age, sex and proteinuria, but not in the use of renin–angiotensin system blockers. The adjusted model suggests that treated (agalsidase beta) patients experienced a slower median eGFR decrease [2.46 mL/min/1.73 m2/year slower; 95% confidence interval (CI) 0.63–4.29; P = 0.0087] than comparable untreated patients. The median eGFR decrease was 2.64 mL/min/1.73 m2/year slower (95% CI 0.53–4.78; P = 0.0141) in treated Classic males. Conclusions Using an expansive evidence base and robust modelling approach, these data indicate that agalsidase beta-treated patients with the Classic phenotype conserve their renal function better than untreated patients.
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Affiliation(s)
- Alberto Ortiz
- Unidad de Diálisis, IIS-Fundación Jiménez Díaz, School of Medicine, UAM, IRSIN and REDINREN, Madrid, Spain
| | - Steve Kanters
- Evidence Synthesis and Decision Modeling, Precision HEOR, Vancouver, BC, Canada
| | - Alaa Hamed
- Sanofi Genzyme Health Economics and Value Assessment, Genzyme, Cambridge, MA, USA
| | | | | | - Manish Maski
- Sanofi Genzyme Medical Affairs, Genzyme, Cambridge, MA, USA
| | - Mario Aguiar
- Sanofi Genzyme Medical Affairs, Genzyme, Cambridge, MA, USA
| | - Elvira Ponce
- Sanofi Genzyme Medical Affairs, Genzyme, Cambridge, MA, USA
| | - Jeroen P Jansen
- Evidence Synthesis and Decision Modeling, Precision HEOR, Oakland, CA, USA
| | - Dieter Ayers
- Evidence Synthesis and Decision Modeling, Precision HEOR, Vancouver, BC, Canada
| | - Rachel Goldgrub
- Evidence Synthesis and Decision Modeling, Precision HEOR, Vancouver, BC, Canada
| | - Robert J Desnick
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Feriozzi S, Hughes DA. New drugs for the treatment of Anderson-Fabry disease. J Nephrol 2020; 34:221-230. [PMID: 32193835 DOI: 10.1007/s40620-020-00721-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/12/2020] [Indexed: 12/22/2022]
Abstract
Enzyme replacement therapy (ERT) of the Anderson-Fabry disease (AFD) has changed the outcome of patients. However, ERT has some limitations: a restricted volume of distribution, requirement for intravenous access, and stimulation of the production of anti-drug antibodies. Studies of new drugs aiming to improve the clinical effectiveness and convenience of therapy have been reported. Migalastat, a pharmacological chaperone, increases available enzymate activity in patients with mutations amenable to the therapy, is now available for clinical practice. It is orally administered, and while clinical trial results are promising, long term real world follow up is awaited. PEGylated enzyme has a longer half-life and potentially reduced antigenicity, compared with standard preparations; investigation of whether a longer dosing interval is viable is under way. Moss-derived enzyme has a higher affinity for mannose receptors, and appears to have access to renal tissue. Substrate reduction therapy is based on reducing the catabolism processes of the glycosphingolipids, and is currently under investigation as monotherapy. Gene therapy has now been initiated in clinical trail of in vivo and ex vivo technologies with early results are emerging. ERT represents a certain milestone of therapy for AFD with Migalastat now a newly available option. Other agents in clinical trial prevent further potential opportunities to improve outcomes in AFD.
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Affiliation(s)
- Sandro Feriozzi
- Nephrology and Dialysis Unit, Belcolle Hospital, Via Sammartinese snc, 01100, Viterbo, Italy.
| | - Derralynn A Hughes
- Lysosomal Storage Disorders Unit, Royal Free London NHS Foundation Trust and University College London, London, UK
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Azevedo O, Gago MF, Miltenberger-Miltenyi G, Robles AR, Costa MA, Pereira O, Vide AT, Castelo Branco G, Simões S, Guimarães MJ, Salgado A, Sousa N, Cunha D. Natural history of the late-onset phenotype of Fabry disease due to the p.F113L mutation. Mol Genet Metab Rep 2020; 22:100565. [PMID: 32099817 PMCID: PMC7026617 DOI: 10.1016/j.ymgmr.2020.100565] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/05/2020] [Accepted: 01/06/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The common GLA gene mutation p.F113L causes late-onset phenotype of Fabry disease (FD) with predominant cardiac manifestations. A founder effect of FD due to this mutation was found in the Portuguese region of Guimarães. Our study aims to deepen the knowledge on the natural history of this late-onset variant. METHODS 203 consecutive adult Fabry patients with p.F113L mutation (79 males; mean age 46 ± 18 years), from this region, were submitted at baseline to a predefined diagnostic protocol. The occurrence of FD manifestations was analyzed in each decade of age in both genders. RESULTS In males, left ventricular hypertrophy (40.2%) and late gadolinium enhancement (21.4%) arose over 30 years; heart failure (HF) (21.9%), ventricular tachycardia (8.9%) and conduction disorders over 40 years; and bifascicular (13.1%) and complete atrioventricular blocks (5.9%) beyond 50 years of age. Cardiac manifestations occurred more commonly and 1-2 decades earlier in males; their frequency increased with age. Septum and posterior wall thickness, LV mass, QRS interval duration and pro-BNP levels increased with age in both genders. Mean survival free from HF (64 ± 1 vs. 76 ± 2 years) and pacemaker (71 ± 2 vs. 86 ± 1 years) was higher in females (p < .001). Albuminuria A2/A3 (33.7%), brain white matter lesions (50.3%) and sensorineural deafness (44.7%) arose before 30 years of age in both genders, increasing with age. Renal failure and stroke were rare. Lysosomal inclusions were demonstrated in podocytes of patients with proteinuria. CONCLUSION This study improves the knowledge on natural history of late-onset variants of FD, carrying major impact on clinical decisions and guidelines.
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Affiliation(s)
- Olga Azevedo
- Cardiology Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal, member of the European Reference Network on Hereditary Metabolic Disorders (MetabERN)
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Miguel F. Gago
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Neurology Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal, member of the European Reference Network on Hereditary Metabolic Disorders (MetabERN)
| | - Gabriel Miltenberger-Miltenyi
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Genetics Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal, member of the European Reference Network on Hereditary Metabolic Disorders (MetabERN)
| | - Ana Raquel Robles
- Otorhinolaryngology Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal, member of the European Reference Network on Hereditary Metabolic Disorders (MetabERN)
| | - Maria Antónia Costa
- Ophthalmology Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal, member of the European Reference Network on Hereditary Metabolic Disorders (MetabERN)
| | - Olga Pereira
- Dermatology Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal, member of the European Reference Network on Hereditary Metabolic Disorders (MetabERN)
| | - Ana Teresa Vide
- Neurorradiology Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal, member of the European Reference Network on Hereditary Metabolic Disorders (MetabERN)
| | - Gonçalo Castelo Branco
- Internal Medicine Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal, member of the European Reference Network on Hereditary Metabolic Disorders (MetabERN)
| | - Sónia Simões
- Psychiatry Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal, member of the European Reference Network on Hereditary Metabolic Disorders (MetabERN)
| | - Maria José Guimarães
- Pneumology Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal, member of the European Reference Network on Hereditary Metabolic Disorders (MetabERN)
| | - Ana Salgado
- Radiology Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal, member of the European Reference Network on Hereditary Metabolic Disorders (MetabERN)
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Damião Cunha
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Lenders M, Brand E. FAbry STabilization indEX (FASTEX): Clinical evaluation of disease progression in Fabry patients. Mol Genet Metab 2020; 129:142-149. [PMID: 31879214 DOI: 10.1016/j.ymgme.2019.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Two established scores, the Mainz Severity Score Index (MSSI) and Fabry Disease Severity Scoring System (DS3), quantify the disease burden in Fabry disease (FD), while the recent developed FAbry STabilization indEX (FASTEX) aims to detect disease progression. OBJECTIVE MSSI, DS3 and FASTEX were compared to evaluate disease stability or progression in a prospective cohort of Fabry patients under enzyme replacement therapy (ERT). METHODS Disease load of 62 patients (28 [45%] females) treated with ERT (26 [42%] under agalsidase-alfa) was assessed using the current scores and re-assessed after 12 months of treatment. Fifteen (24%) patients were ERT-naïve at baseline. RESULTS All scores showed a correlation with each other, while MSSI and DS3 showed the strongest (Pearson r: 0.81, p < .0001). Plasma lyso-Gb3 levels in naïve patients correlated with increasing DS3 and MSSI scores (Pearson r: 0.60, p < .05; Pearson r: 0.64, p < .01; respectively), but not with the total weighted FASTEX score. Longitudinal analysis suggested a stable disease course using DS3 and MSSI. Only males long-term-treated with agalsidase-alfa presented with a slight increase of the general MSSI score (p = .0084). By contrast, the FASTEX score demonstrates that only 21 patients (33.9%) were stable, all other patients presented a disease progression. Patients with an unstable FASTEX mainly suffered from a significant loss of renal function (eGFRcreat: -2.7 ± 7.3 ml/min/1.73 m2, p = .0298). CONCLUSION We conclude that the FASTEX seems to be a simple and user friendly, valuable tool to assess early changes in disease progression even in smaller patient cohorts and short term surveillance.
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Affiliation(s)
- Malte Lenders
- Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, University Hospital Muenster, Muenster, Germany
| | - Eva Brand
- Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, University Hospital Muenster, Muenster, Germany.
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Atiskova Y, Rassuli R, Koehn AF, Golsari A, Wagenfeld L, du Moulin M, Muschol N, Dulz S. Retinal hyperreflective foci in Fabry disease. Orphanet J Rare Dis 2019; 14:296. [PMID: 31878969 PMCID: PMC6933914 DOI: 10.1186/s13023-019-1267-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/02/2019] [Indexed: 11/10/2022] Open
Abstract
Background Fabry disease (FD) is an X-linked inherited storage disorder caused by deficiency of lysosomal alpha-Galactosidase A. Here we describe new retinal findings in patients with FD assessed by Spectral domain optical coherence tomography (SD-OCT) and their possible clinical relevance. Methods 54 eyes of 27 FD patients and 54 eyes of 27 control subjects were included. The ophthalmic examination included visual acuity testing, tonometry, slit lamp and fundus examination. SD-OCT imaging of the macula was performed in all subjects. Central retinal thickness and retinal nerve fiber layer analysis were quantified. Vessel tortuosity was obtained by a subjective scoring and mathematically calculated. Inner retinal hyperreflective foci (HRF) were quantified, clinically graded and correlated with a biomarker of Fabry disease (lyso-Gb3). Results In comparison to an age-matched control group, a significant amount of HRF was identified in macular SD-OCT images in FD patients. These HRF were localized within the inner retinal layers. Furthermore, lyso-Gb3 levels correlated significantly with the quantitative evaluation of HRF (p < 0,001). In addition, the vessel tortuosity was remarkably increased in FD patients compared to control persons and correlated significantly with lyso-G3 levels (p = 0.005). A further subanalysis revealed significantly higher HRF and vessel tortuosity scores in male patients with the classic FD phenotype. Conclusions The observational, cross sectional, comparative study describes novel intraretinal findings in patients with FD. We were able to identify suspicious HRF within the inner retinal layers. These findings were not accompanied by functional limitations, as visual acuity remained unchanged. However, HRF correlated well with lyso-Gb3, a degradation product of the accumulating protein Gb3 and might potentially indicate Gb3 accumulation within the highly metabolic and densely vascularized macula.
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Affiliation(s)
- Yevgeniya Atiskova
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Rahman Rassuli
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Anja Friederike Koehn
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Amir Golsari
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Wagenfeld
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Marcel du Moulin
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicole Muschol
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simon Dulz
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Carvalho Silva D, Marques N, Azevedo O, Miltenberger-Miltenyi G, Bento D, Guedes J, Azevedo P, Bispo J, Mota T, Fernandes R, Nzwalo H, Cabrita A, Ramos A, de Jesus I. p.G360R Is a Pathogenic GLA Gene Mutation Responsible for a Classic Phenotype of Fabry Disease. Cardiology 2019; 144:125-130. [DOI: 10.1159/000502437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 07/28/2019] [Indexed: 11/19/2022]
Abstract
The authors report the case of a classic phenotype of Fabry disease in a 60-year-old male patient presenting with left ventricular hypertrophy and stroke. Genetic analysis revealed 2 GLA-gene variants, i.e., p.R356Q and p.G360R. This clinical case highlights that the finding of 2 or more GLA gene variants in a Fabry patient should lead to a careful evaluation in order to determine their exact role in the condition. This case also provides the first clinical evidence that the p.G360R mutation is pathogenic and responsible for a classic phenotype of Fabry disease. The clinical improvement following the initiation of enzyme replacement therapy reinforces the importance of Fabry disease awareness and diagnosis in patients exhibiting red flags, such as left ventricular hypertrophy and stroke.
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Michaud L. Longitudinal study on ocular manifestations in a cohort of patients with Fabry disease. PLoS One 2019; 14:e0213329. [PMID: 31246960 PMCID: PMC6597042 DOI: 10.1371/journal.pone.0213329] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 05/26/2019] [Indexed: 12/11/2022] Open
Abstract
Purpose This study aims to assess the evolution of ocular manifestations in a cohort of Fabry patients. Methods This is a prospective observational study conducted from 2013 to 2017 (5 consecutive exams). All subjects underwent a comprehensive ocular examination including oriented case history, refraction, corneal topography, biomechanical corneal properties and pachometry assessments, aberrometry, anterior segment evaluation, double-frequency visual field (FDT), intra-ocular pressure, and ocular fundus. At baseline, 41 subjects enrolled but 9 dropped-out and 4 files were not kept for analysis (missing data). Remaining 28 subjects were classified into: Group 1 -hemizygotes (HMZ), all on enzyme replacement therapy (ERT) (N = 10); Group 2 -heterozygotes (HTZ) actively ERT-treated (N = 8), and Group 3 -HTZ not treated (N = 10). Results There is a high intra and inter-subjects variability. At baseline, prevalence of the ocular manifestations found is similar to published data: cornea verticillata (89.2%), conjunctival vessels tortuosity (85.7%), corneal haze (67.8%), retinal vessels tortuosity (64.2%), anterior cataract (39.2%) and posterior cataract (28.5%). Prevalence for new elements are found: upper lid vessels toricity (96.4%) and micro-aneurysms (42.8%). At the end, micro-aneurysms (+82%), posterior cataract (+75%) corneal haze (+21%) anterior cataract (+17%) and retinal vessels tortuosities (+4%) evolved in prevalence and severity despite the fact that 68% of the patients were on ERT. Treated heterozygotes evolved more than other groups (p>0.05). Conclusion ERT does not seem to halt the clinical evolution of several ocular manifestations. Longer observational time and objective grading systems may be required to fully confirm these findings.
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Affiliation(s)
- Langis Michaud
- École d’optométrie, Université de Montréal, Montréal, Québec, Canada
- * E-mail:
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Polo G, Burlina AP, Ranieri E, Colucci F, Rubert L, Pascarella A, Duro G, Tummolo A, Padoan A, Plebani M, Burlina AB. Plasma and dried blood spot lysosphingolipids for the diagnosis of different sphingolipidoses: a comparative study. ACTA ACUST UNITED AC 2019; 57:1863-1874. [DOI: 10.1515/cclm-2018-1301] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/14/2019] [Indexed: 12/20/2022]
Abstract
Abstract
Background
Lysosphingolipids, the N-deacylated forms of sphingolipids, have been identified as potential biomarkers of several sphingolipidoses, such as Gaucher, Fabry, Krabbe and Niemann-Pick diseases and in GM1 and GM2 gangliosidoses. To date, different methods have been developed to measure various lysosphingolipids (LysoSLs) in plasma. Here, we present a novel liquid chromatography tandem mass spectrometry (LC-MS/MS) assay for a simultaneous quantification of LysoSLs (HexSph, LysoGb3, LysoGM1, LysoGM2, LysoSM and LysoSM509) in dried blood spot (DBS). This LC-MS/MS method was used to compare the levels of LysoSLs in DBS and plasma in both affected patients and healthy controls.
Methods
Lysosphingolipids were extracted from a 3.2 mm diameter DBS with a mixture of methanol:acetonitrile:water (80:15:5, v/v) containing internal stable isotope standards. Chromatographic separation was performed using a C18 column with a gradient of water and acetonitrile both with 0.1% formic acid in a total run time of 4 min. The compounds were detected in the positive ion mode electrospray ionization (ESI)-MS/MS by multiple reaction monitoring (MRM).
Results
The method was validated on DBS to demonstrate specificity, linearity, lowest limit of quantification, accuracy and precision. The reference ranges were determined in pediatric and adult populations. The elevated levels of LysoSLs were identified in Gaucher disease (HexSph), Fabry disease (LysoGb3), prosaposin deficiency (HexSph and LysoGb3) and Niemann-Pick disease types A/B and C (LysoSM and LysoSM509). The correlation in the levels between DBS and plasma was excellent for LysoGb3 and HexSph but poor for LysoSM and LysoSM509.
Conclusions
Despite the fact that plasma LysoSLs determination remains the gold standard, our LC-MS/MS method allows a rapid and reliable quantification of lysosphingolipids in DBS. The method is a useful tool for the diagnosis of different sphingolipidoses except for Niemann-Pick type C.
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Affiliation(s)
- Giulia Polo
- Division of Inherited Metabolic Diseases, Regional Center for Expanded Neonatal Screening, Department of Women and Children’s Health , University Hospital of Padova , Padova , Italy
| | | | - Enzo Ranieri
- Department of Biochemical Genetics, Directorate of Genetics and Molecular Pathology, SA Pathology , Women’s and Children’s Hospital , North Adelaide , South Australia , Australia
| | - Francesca Colucci
- Division of Inherited Metabolic Diseases, Regional Center for Expanded Neonatal Screening, Department of Women and Children’s Health , University Hospital of Padova , Padova , Italy
| | - Laura Rubert
- Division of Inherited Metabolic Diseases, Regional Center for Expanded Neonatal Screening, Department of Women and Children’s Health , University Hospital of Padova , Padova , Italy
| | - Antonia Pascarella
- Division of Inherited Metabolic Diseases, Regional Center for Expanded Neonatal Screening, Department of Women and Children’s Health , University Hospital of Padova , Padova , Italy
| | - Giovanni Duro
- Institute of Biomedicine and Molecular Immunology (IBIM) , National Research Council , Palermo , Italy
| | - Albina Tummolo
- Department of Metabolic Diseases, Clinical Genetics and Diabetology , Giovanni XXIII Children’s Hospital , Bari , Italy
| | - Andrea Padoan
- Department Laboratory Medicine , University Hospital of Padova , Padova , Italy
| | - Mario Plebani
- Department Laboratory Medicine , University Hospital of Padova , Padova , Italy
| | - Alberto B. Burlina
- Division of Inherited Metabolic Diseases, Regional Center for Expanded Neonatal Screening, Department of Women and Children’s Health , University Hospital of Padova , Padova , Italy
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van der Veen SJ, van Kuilenburg ABP, Hollak CEM, Kaijen PHP, Voorberg J, Langeveld M. Antibodies against recombinant alpha-galactosidase A in Fabry disease: Subclass analysis and impact on response to treatment. Mol Genet Metab 2019; 126:162-168. [PMID: 30473480 DOI: 10.1016/j.ymgme.2018.11.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/16/2018] [Accepted: 11/12/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Treatment of Fabry disease (FD) with recombinant alpha-galactosidase A (r-αGAL A) is complicated by the formation of anti-drug antibodies in the majority of male patients with the classical disease phenotype. Detailed information regarding antibody subtypes, onset and persistence of antibody development and their effect on treatment efficacy is sparse. METHODS A retrospective study was carried out in 39 male patients with classical FD, treated with either agalsidase-alfa or agalsidase-beta (mean follow up of 10 years). With six to twelve months intervals plasma-induced in vitro inhibition of enzyme activity, lysoglobotriaosylsphingosine (lysoGb3) levels and renal function were assessed. In a subset of 12 patients, additionally anti- r-αGAL A IgM, IgA and IgG1, 2, 3 and 4 levels were analyzed. RESULTS In 23 out of 39 patients, plasma-induced in vitro inhibition of r-αGAL A activity was observed (inhibition-positive). The inhibition titer was strongly negatively correlated to the decrease in lysoGb3: agalsidase-alfa (FElog10(inhibition) = -10.3, P ≤.001), agalsidase-beta (FElog10(inhibition) = -4.7, P ≤.001). Inhibition-positive patients had an accelerated decline in renal function (FE = 1.21, p = .042). During treatment IgG1 anti-r-αGAL A levels increased only in inhibition-positive patients (p = .0045). IgG4 anti-r-αGAL A antibodies developed in 7 out of 9 inhibition-positive patients. Other antibody subclasses were either not present or too low to quantify. CONCLUSION Development of inhibiting antibodies against r-αGAL A negatively affects the biochemical response to ERT and resulted in an accelerated decline in renal function. The presence of IgG1 and IgG4 anti-r-αGAL A antibodies is associated with in vitro αGAL A activity inhibition.
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Affiliation(s)
- S J van der Veen
- Amsterdam UMC, University of Amsterdam, Department of Endocrinology and Metabolism, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - A B P van Kuilenburg
- Amsterdam UMC, University of Amsterdam, Department of Clinical Chemistry, Gastroenterology & Metabolism Laboratory, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - C E M Hollak
- Amsterdam UMC, University of Amsterdam, Department of Endocrinology and Metabolism, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - P H P Kaijen
- Department of Plasma Proteins, Sanquin-AMC Landsteiner Laboratory, Sanquin Research, Plesmanlaan 125, 1066 CX Amsterdam, the Netherlands
| | - J Voorberg
- Department of Plasma Proteins, Sanquin-AMC Landsteiner Laboratory, Sanquin Research, Plesmanlaan 125, 1066 CX Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Vascular Medicine, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - M Langeveld
- Amsterdam UMC, University of Amsterdam, Department of Endocrinology and Metabolism, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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46
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Artola M, Hedberg C, Rowland RJ, Raich L, Kytidou K, Wu L, Schaaf A, Ferraz MJ, van der Marel GA, Codée JDC, Rovira C, Aerts JMFG, Davies GJ, Overkleeft HS. α-d-Gal-cyclophellitol cyclosulfamidate is a Michaelis complex analog that stabilizes therapeutic lysosomal α-galactosidase A in Fabry disease. Chem Sci 2019. [DOI: 10.1039/c9sc03342d] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
α-d-Gal-cyclophellitol cyclosulfamidate is a new class of neutral, conformationally-constrained competitive glycosidase inhibitor that stabilizes α-gal A and prevents its degradation both in vitro and in cellulo by mimicry of the Michaelis complex conformation.
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47
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Üçeyler N, Böttger J, Henkel L, Langjahr M, Mayer C, Nordbeck P, Wanner C, Sommer C. Detection of blood Gb3 deposits as a new tool for diagnosis and therapy monitoring in patients with classic Fabry disease. J Intern Med 2018; 284:427-438. [PMID: 29974530 DOI: 10.1111/joim.12801] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The X-linked Fabry disease (FD) is a multiorgan disorder due to alpha-galactosidase A (α-GAL) deficiency with consequent lysosomal accumulation of globotriaosylceramide (Gb3). We established the immunocytochemical detection of Gb3 in blood cells of FD patients as a new method for FD diagnostics, follow-up and treatment control. METHODS We enrolled 67 FD patients (37 men, 30 women) and 52 healthy controls (26 men, 26 women). PBMC were isolated from whole venous blood and 3x105 cells were immunoreacted with antibodies against CD77 as a marker for Gb3. Using fluorescence microscopy, the mean percentage of Gb3 positive PBMC was determined by an investigator blinded to subject allocation. As a second method, we qualitatively assessed Gb3 positive cells in blood smears. RESULTS Gb3 deposits were unequivocally visible in PBMC and in blood smears. Men (P < 0.001) and women (P < 0.01) with classical FD had more Gb3-positive PBMC than healthy controls, whose samples only occasionally showed positive cells. The number of Gb3 positive PBMC was negatively correlated with α-GAL activity and positively correlated with plasma lyso-Gb3 levels. Only the PBMC Gb3 load but not plasma lyso-Gb3 reflected short- and long-term effects of enzyme replacement therapy (P < 0.01). CONCLUSIONS Gb3 can be visualized in PBMC and blood smears and can be used as a novel marker for diagnostics, follow-up and treatment control in FD.
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Affiliation(s)
- N Üçeyler
- Department of Neurology, University of Würzburg, Würzburg, Germany.,Fabry Center for Interdisciplinary Therapy Würzburg (FAZIT), University of Würzburg, Würzburg, Germany
| | - J Böttger
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - L Henkel
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - M Langjahr
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - C Mayer
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - P Nordbeck
- Fabry Center for Interdisciplinary Therapy Würzburg (FAZIT), University of Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University of Würzburg, Würzburg, Germany
| | - C Wanner
- Fabry Center for Interdisciplinary Therapy Würzburg (FAZIT), University of Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University of Würzburg, Würzburg, Germany
| | - C Sommer
- Department of Neurology, University of Würzburg, Würzburg, Germany.,Fabry Center for Interdisciplinary Therapy Würzburg (FAZIT), University of Würzburg, Würzburg, Germany
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48
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Lenders M, Brand E. Effects of Enzyme Replacement Therapy and Antidrug Antibodies in Patients with Fabry Disease. J Am Soc Nephrol 2018; 29:2265-2278. [PMID: 30093456 DOI: 10.1681/asn.2018030329] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Malte Lenders
- Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, University Hospital Muenster, Muenster, Germany
| | - Eva Brand
- Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, University Hospital Muenster, Muenster, Germany
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49
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Wanner C, Arad M, Baron R, Burlina A, Elliott PM, Feldt-Rasmussen U, Fomin VV, Germain DP, Hughes DA, Jovanovic A, Kantola I, Linhart A, Mignani R, Monserrat L, Namdar M, Nowak A, Oliveira JP, Ortiz A, Pieroni M, Spada M, Tylki-Szymańska A, Tøndel C, Viana-Baptista M, Weidemann F, Hilz MJ. European expert consensus statement on therapeutic goals in Fabry disease. Mol Genet Metab 2018; 124:189-203. [PMID: 30017653 DOI: 10.1016/j.ymgme.2018.06.004] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/31/2018] [Accepted: 06/10/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Fabry disease, an inherited lysosomal storage disorder, causes multi-organ pathology resulting in substantial morbidity and a reduced life expectancy. Although Fabry disease is an X-linked disorder, both genders may be affected, but generally to a lesser extent in females. The disease spectrum ranges from classic early-onset disease to non-classic later-onset phenotypes, with complications occurring in multiple organs or being confined to a single organ system depending on the stage of the disease. The impact of therapy depends upon patient- and disease-specific factors and timing of initiation. METHODS A European panel of experts collaborated to develop a set of organ-specific therapeutic goals for Fabry disease, based on evidence identified in a recent systematic literature review and consensus opinion. RESULTS A series of organ-specific treatment goals were developed. For each organ system, optimal treatment strategies accounted for inter-patient differences in disease severity, natural history, and treatment responses as well as the negative burden of therapy and the importance of multidisciplinary care. The consensus therapeutic goals and proposed patient management algorithm take into account the need for early disease-specific therapy to delay or slow the progression of disease as well as non-specific adjunctive therapies that prevent or treat the effects of organ damage on quality of life and long-term prognosis. CONCLUSIONS These consensus recommendations help advance Fabry disease management by considering the balance between anticipated clinical benefits and potential therapy-related challenges in order to facilitate individualized treatment, optimize patient care and improve quality of life.
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Affiliation(s)
- Christoph Wanner
- Division of Nephrology, University Clinic, University of Würzburg, Würzburg, Germany.
| | - Michael Arad
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Tel Aviv University, Israel
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | | | - Perry M Elliott
- Barts Heart Centre, University College London, London, United Kingdom
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology, Section 2132, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Victor V Fomin
- I.M. Sechenov First Moscow State Medical University, Department of Internal Diseases No. 1, Moscow, Russian Federation
| | - Dominique P Germain
- French Referral Center for Fabry disease, Division of Medical Genetics and INSERM U1179, University of Versailles, Paris-Saclay University, Montigny, France
| | - Derralynn A Hughes
- Lysosomal Storage Disorders Unit, Department of Haematology, Royal Free London NHS Foundation Trust, University College London, United Kingdom
| | - Ana Jovanovic
- Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Ilkka Kantola
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Aleš Linhart
- Second Department of Medicine - Department of Cardiovascular Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Renzo Mignani
- Department of Nephrology, Infermi Hospital, Rimini, Italy
| | | | - Mehdi Namdar
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Albina Nowak
- University Heart Center, University Hospital of Zurich and University of Zurich, Zurich, Switzerland
| | - João-Paulo Oliveira
- Department of Genetics, São João Hospital Centre & Faculty of Medicine and "Instituto de Investigação e Inovação em Saúde (i3S)", University of Porto, Porto, Portugal
| | - Alberto Ortiz
- Unidad de Diálisis, IIS-Fundación Jiménez Díaz/UAM, IRSIN and REDINREN, Madrid, Spain
| | | | - Marco Spada
- Department of Paediatrics, University of Torino, Torino, Italy
| | - Anna Tylki-Szymańska
- Department of Paediatrics, Nutrition and Metabolic Diseases, Children's Memorial Health Institute, Warsaw, Poland
| | - Camilla Tøndel
- Department of Paediatrics, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Miguel Viana-Baptista
- Serviço de Neurologia, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, CEDOC Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Frank Weidemann
- Department of Cardiology, Innere Klinik II, Katharinen-Hospital, Unna, Germany
| | - Max J Hilz
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
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50
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Cammarata G, Scalia S, Colomba P, Zizzo C, Pisani A, Riccio E, Montalbano M, Alessandro R, Giordano A, Duro G. A pilot study of circulating microRNAs as potential biomarkers of Fabry disease. Oncotarget 2018; 9:27333-27345. [PMID: 29937989 PMCID: PMC6007950 DOI: 10.18632/oncotarget.25542] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/16/2018] [Indexed: 11/25/2022] Open
Abstract
Patients suffering from Fabry disease (FD), a lysosomal storage disorder, show a broad range of symptoms and the diagnosis followed by the therapeutic decision remains a great challenge. The biomarkers available today have not proven to be useful for predicting the evolution of the disease and for assessing response to therapy in many patients. Here, we used high-throughput microRNA profiling methodology to identify a specific circulating microRNA profile in FD patients. We discovered a pattern of 10 microRNAs able to identify FD patients when compared to healthy controls. Notably, two of these: the miR199a-5p and the miR-126-3p are able to discriminate FDs from the control subjects with left ventricular hypertrophy, a frequent but non-specific FD symptom. These same microRNAs are also sensitive to enzyme replacement therapy showing variation in the subjects under treatment. Furthermore, two other microRNAs of the profile, the miR-423-5p and the miR-451a, seem useful to highlight cardiac involvement in FD patients. A literature and database search revealed that miR-199a-5p, miR-126-3p, miR-423-5p and miR-451a are known to be linked to pathological states that occur during the FD development. In particular, miR-199a-5p, and miR-126-3p are involved in endothelial dysfunction and miR-423-5p and miR-451a in myocardial remodeling. In conclusion, in this study we identified a common plasma microRNA profile in FD patients, useful not only for the correct classification of Fabry patients regardless of sex and age, but also to evaluate the response to therapy. Furthermore, our observations suggest that some microRNAs of this profile demonstrate prognostic qualities.
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Affiliation(s)
- Giuseppe Cammarata
- Institute of Biomedicine and Molecular Immunology, National Research Council, Palermo, Italy
| | - Simone Scalia
- Institute of Biomedicine and Molecular Immunology, National Research Council, Palermo, Italy
| | - Paolo Colomba
- Institute of Biomedicine and Molecular Immunology, National Research Council, Palermo, Italy
| | - Carmela Zizzo
- Institute of Biomedicine and Molecular Immunology, National Research Council, Palermo, Italy
| | - Antonio Pisani
- Department of Public Health, Section of Nephrology, Federico II University of Naples, Naples, Italy
| | - Eleonora Riccio
- Department of Public Health, Section of Nephrology, Federico II University of Naples, Naples, Italy
| | - Michaela Montalbano
- Institute of Biomedicine and Molecular Immunology, National Research Council, Palermo, Italy
| | - Riccardo Alessandro
- Institute of Biomedicine and Molecular Immunology, National Research Council, Palermo, Italy
- Department of Biopathology and Medical Biotechnology, University of Palermo, Palermo, Italy
| | | | - Giovanni Duro
- Institute of Biomedicine and Molecular Immunology, National Research Council, Palermo, Italy
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