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Abstract
OBJECTIVES Fabry disease (FD) is an X-linked lysosomal storage disorder that causes multisystem involvement, including ear disease. In this study, we aimed to investigate the nature of auditory issues in FD using a wide spectrum of audiological tests. DESIGN This cross-sectional study was conducted between June 2017 and December 2018. We collected the clinical and laboratory data of 40 eligible FD patients, 45 healthy subjects, and 26 diabetic controls. All patients and controls completed audiologic evaluations that included tympanometry, acoustic reflex threshold test, reflex decay test, pure-tone audiometry, speech audiometry, transient otoacoustic emissions (TEOAEs), high-frequency audiometry, and distortion product otoacoustic emission (DPOAE). RESULTS In our study population, hearing was reduced at higher frequencies starting at 4 kHz in both the FD and diabetic groups. Regarding the acoustic reflex threshold test, FD and diabetic patients had similar results. In all frequencies, positive decay was significantly more frequent in FD patients when compared with the diabetic patients and healthy controls (p < 0.001 for each ear). The FD patients and healthy controls had similar results for DPOAE testing. CONCLUSIONS We showed that FD patients had a higher rate of reflex decay, indicating retrocochlear involvement. Thus, further investigation of factors associated with retrocochlear involvement could be investigated, such as ABR and speech in noise tests.
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Del Tredici K, Ludolph AC, Feldengut S, Jacob C, Reichmann H, Bohl JR, Braak H. Fabry Disease With Concomitant Lewy Body Disease. J Neuropathol Exp Neurol 2020; 79:378-392. [PMID: 32016321 PMCID: PMC7092358 DOI: 10.1093/jnen/nlz139] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 11/07/2019] [Accepted: 12/15/2019] [Indexed: 12/20/2022] Open
Abstract
Although Gaucher disease can be accompanied by Lewy pathology (LP) and extrapyramidal symptoms, it is unknown if LP exists in Fabry disease (FD), another progressive multisystem lysosomal storage disorder. We aimed to elucidate the distribution patterns of FD-related inclusions and LP in the brain of a 58-year-old cognitively unimpaired male FD patient suffering from predominant hypokinesia. Immunohistochemistry (CD77, α-synuclein, collagen IV) and neuropathological staging were performed on 100-µm sections. Tissue from the enteric or peripheral nervous system was unavailable. As controls, a second cognitively unimpaired 50-year-old male FD patient without LP or motor symptoms and 3 age-matched individuals were examined. Inclusion body pathology was semiquantitatively evaluated. Although Lewy neurites/bodies were not present in the 50-year-old individual or in controls, severe neuronal loss in the substantia nigra pars compacta and LP corresponding to neuropathological stage 4 of Parkinson disease was seen in the 58-year-old FD patient. Major cerebrovascular lesions and/or additional pathologies were absent in this individual. We conclude that Lewy body disease with parkinsonism can occur within the context of FD. Further studies determining the frequencies of both inclusion pathologies in large autopsy-controlled FD cohorts could help clarify the implications of both lesions for disease pathogenesis, potential spreading mechanisms, and therapeutic interventions.
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Affiliation(s)
- Kelly Del Tredici
- Clinical Neuroanatomy Section, Department of Neurology, Center for Biomedical Research, University of Ulm
| | | | - Simone Feldengut
- Clinical Neuroanatomy Section, Department of Neurology, Center for Biomedical Research, University of Ulm
| | - Christian Jacob
- Clinical Neuroanatomy Section, Department of Neurology, Center for Biomedical Research, University of Ulm.,Institute for Anatomy and Cell Biology, University of Ulm, Ulm
| | - Heinz Reichmann
- Department of Neurology, Dresden University of Technology, Dresden
| | - Jürgen R Bohl
- Institute of Neuropathology, University of Mainz, Mainz, Germany
| | - Heiko Braak
- Clinical Neuroanatomy Section, Department of Neurology, Center for Biomedical Research, University of Ulm
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Chaves-Markman ÂV, Markman M, Calado EB, Pires RF, Santos-Veloso MAO, Pereira CMF, Lordsleem ABDMDS, Lima SGD, Markman Filho B, Oliveira DCD. GLA Gene Mutation in Hypertrophic Cardiomyopathy with a New Variant Description: Is it Fabry's Disease? Arq Bras Cardiol 2019; 113:77-84. [PMID: 31291414 PMCID: PMC6684188 DOI: 10.5935/abc.20190112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/01/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Fabry disease (FD) is an X-linked lysosomal storage disorder caused by mutations in the alpha galactosidase A gene (GLA) that lead to the enzymatic deficiency of alpha galactosidase (α-Gal A), resulting in the accumulation of globotriaosylceramide (Gb3) and globotriaosylsphingosine (lyso-Gb3), causing multiple organ dysfunctions. OBJECTIVE To perform GLA gene screening in a group of patients with echocardiographic diagnosis of hypertrophic cardiomyopathy (HCM). METHODS a cross-sectional study was conducted with HCM patients from a university hospital. Patients with coronary artery disease and valvulopathies were excluded. Mutation analysis of the GLA gene was performed. In male subjects, the analysis was performed after evidence of low α-Gal A activity. RESULTS 60 patients with echocardiographic diagnosis of HCM were included. Age ranged from 12 to 85 years and 60% were women. Mean myocardial fibrosis percentage on MRI was 10.7 ± 13.1% and mean ventricular thickness was18.7 ± 6.7 mm. Four patients had the following GLA gene mutations: c.967C>A (p.Pro323Thr), not yet described in the literature; c.937G>T (p.Asp313Tyr); and c.352C>T (p.Arg118Cys). All patients had normal levels of lyso-Gb3 and non-ischemic myocardial fibrosis on magnetic resonance imaging; one patient had proteinuria and one patient had ventricular tachycardia. CONCLUSION in this study, the frequency of mutation in the GLA gene in patients with HCM was 6.7%. A novel mutation in exon 6 of the GLA gene, c.967C>A (p.Pro323Thr), was identified. Patients with HCM may have GLA mutations and FD should be ruled out. Plasma (lyso-Gb3) levels do not seem to be sufficient to attain a diagnosis and organ biopsy should be considered.
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Affiliation(s)
- Ândrea Virgínia Chaves-Markman
- Universidade Federal de Pernambuco - Hospital das Clínicas - Área Acadêmica de Medicina Clínica - Centro de Medicina Clínica - CCM, Recife, PE - Brazil.,Hospital Agamenon Magalhães, Recife, PE - Brazil.,Universidade Federal de Pernambuco - Grupo de pesquisa em Epidemiologia e Cardiologia (EPICARDIO), Recife, PE - Brazil.,Pós Graduação em Inovação Terapêutica (PPGIT) - Universidade Federal de Pernambuco, Recife, PE - Brasil.,Centro Universitário Mauricio de Nassau - Curso de Medicina, Recife, PE - Brasil
| | | | - Eveline Barros Calado
- Universidade Federal de Pernambuco - Hospital das Clínicas - Área Acadêmica de Medicina Clínica - Centro de Medicina Clínica - CCM, Recife, PE - Brazil
| | | | - Marcelo Antônio Oliveira Santos-Veloso
- Universidade Federal de Pernambuco - Grupo de pesquisa em Epidemiologia e Cardiologia (EPICARDIO), Recife, PE - Brazil.,Pós Graduação em Inovação Terapêutica (PPGIT) - Universidade Federal de Pernambuco, Recife, PE - Brasil.,Centro Universitário Mauricio de Nassau - Curso de Medicina, Recife, PE - Brasil
| | | | - Andréa Bezerra de Melo da Silveira Lordsleem
- Universidade Federal de Pernambuco - Hospital das Clínicas - Área Acadêmica de Medicina Clínica - Centro de Medicina Clínica - CCM, Recife, PE - Brazil.,Universidade Federal de Pernambuco - Grupo de pesquisa em Epidemiologia e Cardiologia (EPICARDIO), Recife, PE - Brazil.,Centro Universitário Mauricio de Nassau - Curso de Medicina, Recife, PE - Brasil
| | - Sandro Gonçalves de Lima
- Universidade Federal de Pernambuco - Hospital das Clínicas - Área Acadêmica de Medicina Clínica - Centro de Medicina Clínica - CCM, Recife, PE - Brazil.,Universidade Federal de Pernambuco - Grupo de pesquisa em Epidemiologia e Cardiologia (EPICARDIO), Recife, PE - Brazil.,Centro Universitário Mauricio de Nassau - Curso de Medicina, Recife, PE - Brasil
| | - Brivaldo Markman Filho
- Universidade Federal de Pernambuco - Hospital das Clínicas - Área Acadêmica de Medicina Clínica - Centro de Medicina Clínica - CCM, Recife, PE - Brazil
| | - Dinaldo Cavalcanti de Oliveira
- Universidade Federal de Pernambuco - Hospital das Clínicas - Área Acadêmica de Medicina Clínica - Centro de Medicina Clínica - CCM, Recife, PE - Brazil.,Pós Graduação em Inovação Terapêutica (PPGIT) - Universidade Federal de Pernambuco, Recife, PE - Brasil.,Centro Universitário Mauricio de Nassau - Curso de Medicina, Recife, PE - Brasil
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Eyermann C, Raguin T, Rohmer D, Noel E, Charpiot A. Cochleovestibular manifestations in Fabry disease: Importance of screening and systematic ENT evaluation. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:273-279. [PMID: 31072727 DOI: 10.1016/j.anorl.2019.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Fabry disease (FD) is an X-linked inherited lysosomal storage disease. It is a multisystem pathology that can include ENT disorders. The aim of the present study was to investigate the cochleovestibular manifestations of FD, in order to show the importance of screening and systematic ENT evaluation. MATERIAL AND METHODS A single-center retrospective study included 14 male and 23 female FD patients. Hearing impairment was defined as hearing loss greater than the 90th percentile for at least one frequency. Vestibular impairment was defined by lateral semicircular canal dysfunction. Age, ongoing enzyme replacement therapy (ERT) and organic (renal, cardiac and cerebrovascular) complications were used as severity markers. RESULTS Hearing impairment was found in 62.6% of cases, mostly at high frequencies, and was associated with age, ERT, and cardiac and cerebrovascular disorder. It affected 46.7% of asymptomatic adult patients. Vestibular impairment was found in 56% of cases, associated with age; it affected two-thirds of ERT patients, more than 60% of patients with organic complications, and 50% of asymptomatic adult patients. CONCLUSIONS More than half of patients had ENT involvement. All FD patients should undergo early ENT screening for diagnostic, prognostic and therapeutic purposes. Systematic complete ENT follow-up with auditory and vestibular evaluation should be performed regularly, even for heterozygous women.
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Affiliation(s)
- C Eyermann
- Service d'ORL et de chirurgie cervico-faciale, CHU de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67000 Strasbourg, France.
| | - T Raguin
- Service d'ORL et de chirurgie cervico-faciale, CHU de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67000 Strasbourg, France
| | - D Rohmer
- Service d'ORL et de chirurgie cervico-faciale, CHU de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67000 Strasbourg, France
| | - E Noel
- Service de médecine interne, diabète et maladies métaboliques, CHU de Strasbourg, hôpital Civil, 1, place de l'hôpital, 67000 Strasbourg, France
| | - A Charpiot
- Service d'ORL et de chirurgie cervico-faciale, CHU de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67000 Strasbourg, France
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Sodré LSDS, Huaira RMNH, Bastos MG, Colugnati FAB, Coutinho MP, Fernandes NMDS. Screening for Fabry Disease in Kidney Disease: a Cross-Sectional Study in Males and Females. Kidney Blood Press Res 2017; 42:1258-1265. [PMID: 29248912 DOI: 10.1159/000485929] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 12/03/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Evaluate the prevalence of Fabry disease in men and women with kidney disease; and observe the presence and importance of the main signs and symptoms in patients with kidney disease. METHODS A cross-sectional analysis of secondary data from a multicenter project of Clinical and Epidemiological Analysis of Fabry Disease in 854 Dialysis Centers. A total of 36,442 patients underwent the questionnaire and algorithm; of them, 28,284 were discarded for not presenting signs and symptoms of Fabry disease, while the other 8,087 submitted to blood collection and analysis. All participants signed a Free and Informed Consent Form and a questionnaire was applied. The questionnaire data were analyzed using a computerized algorithm. This program/algorithm analyzes and separates patients into: discarded, patients unlikely to have Fabry disease; suspect, patients who submitted to blood collection. The blood of suspect patients was collected on filter paper for enzyme measurement and genetic testing. A descriptive data analysis was performed and the likelihood ratio was determined. RESULTS The general prevalence was 0.19% and after use of algorithm was 0.87%. Although more men were screened (59.3%), the prevalence was higher in women (65.1%). The most prevalent signs and symptoms were: heart disease (60.6%), decreased or lack of sweating (42.3%), heat and cold intolerance (28.2%), and pain crises spreading throughout the body (26.8%). CONCLUSION The prevalence was higher in women, and the most prevalent symptom was heart diseases.
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Sené T, Lidove O, Sebbah J, Darondel JM, Picard H, Aaron L, Fain O, Zenone T, Joly D, Charron P, Ziza JM. Cardiac device implantation in Fabry disease: A retrospective monocentric study. Medicine (Baltimore) 2016; 95:e4996. [PMID: 27749559 PMCID: PMC5059061 DOI: 10.1097/md.0000000000004996] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The incidence and predictive factors of arrhythmias and/or conduction abnormalities (ACAs) requiring cardiac device (CD) implantation are poorly characterized in Fabry disease (FD). The aim of our retrospective study was to determine the prevalence, incidence, and factors associated with ACA requiring CD implantation in a monocentric cohort of patients with confirmed FD who were followed up in a department of internal medicine and reference center for FD.Forty-nine patients (20M, 29F) were included. Nine patients (4M, 5F; 18%) had at least one episode of ACA leading to device therapy. Six patients (4M/2F) required a pacemaker (PM) for sinus node dysfunction (n = 4) or atrioventricular disease (n = 2). One female patient required an internal cardioverter-defibrillator (ICD) to prevent sudden cardiac death because of nonsustained ventricular tachycardia (nSVT). One female patient required PM-ICD for sinus node dysfunction and nSVT. One patient underwent CD implantation before the diagnosis of FD. The annual rate of CD implantation was estimated at 1.90 per 100 person years. On univariate analysis at the end of the follow-up period, the factors associated with ACAs requiring CD implantation were as follows: delayed diagnosis of FD, delayed initiation of enzyme replacement therapy, age at the last follow-up visit, and severe multiorgan phenotype (hypertrophic cardiomyopathy, chronic kidney disease, and/or sensorineural hearing loss). On multivariate analysis, age at diagnosis of FD and age at the last follow-up visit were independently associated with an increased risk of ACAs requiring CD (P < 0.05).Considering the high frequency of ACAs requiring CD implantation and the risk of sudden death in patients with FD, regular monitoring is mandatory, especially in patients with a late diagnosis of FD and/or with a severe phenotype. Regular Holter ECGs, therapeutic education of patients, and deliverance of an emergency card including a phenotype summary are crucial in the care of FD patients.Available guidelines for device therapy and the efficacy of enzyme replacement therapy for arrhythmias or conduction abnormalities are discussed.
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Affiliation(s)
- Thomas Sené
- Department of Internal Medicine and Rheumatology, Reference Center for Lysosomal Storage Disorders (CRML, site Avron), Groupe Hospitalier Diaconesses Croix-Saint-Simon
| | - Olivier Lidove
- Department of Internal Medicine and Rheumatology, Reference Center for Lysosomal Storage Disorders (CRML, site Avron), Groupe Hospitalier Diaconesses Croix-Saint-Simon
- Inserm UMRS 974, Université Pierre & Marie Curie
- Correspondence: Olivier Lidove, Service de Médecine Interne-Rhumatologie, Hôpital de la Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France (e-mail: )
| | - Joel Sebbah
- Department of Cardiology, Institut Mutualiste Montsouris
| | | | - Hervé Picard
- Department of Clinical Research, Fondation Ophtalmologique Rothschild, Paris
| | - Laurent Aaron
- Department of Internal Medicine, Centre Hospitalier Jacques Coeur, Bourges
| | - Olivier Fain
- Department of Internal Medicine, Hôpital Saint-Antoine, AP-HP, Université Pierre & Marie Curie, Paris
| | - Thierry Zenone
- Department of Internal Medicine, Centre Hospitalier de Valence, Valence
| | - Dominique Joly
- Department of Nephrology, Hôpital Necker, AP-HP, Université René Descartes, Paris
| | - Philippe Charron
- Referral Center For Cardiac Hereditary Diseases, Hôpital Pitié-Salpêtrière, AP-HP, Université Versailles-Saint-Quentin, Saint-Quentin-en-Yvelines, France
| | - Jean-Marc Ziza
- Department of Internal Medicine and Rheumatology, Reference Center for Lysosomal Storage Disorders (CRML, site Avron), Groupe Hospitalier Diaconesses Croix-Saint-Simon
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Lidove O, Barbey F, Niu DM, Brand E, Nicholls K, Bizjajeva S, Hughes DA. Fabry in the older patient: Clinical consequences and possibilities for treatment. Mol Genet Metab 2016; 118:319-25. [PMID: 27221354 DOI: 10.1016/j.ymgme.2016.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/13/2016] [Accepted: 05/13/2016] [Indexed: 02/06/2023]
Abstract
Baseline demographic and phenotypic characteristics of patients aged ≥50years in the Fabry Outcome Survey (Shire; data extracted June 2014) were compared with younger adults to investigate potential factors influencing treatment decisions in later life. Age groups were defined using age at treatment initiation or at FOS entry for untreated patients: 18-49 (n=1344; 49.5% male; 64.6% received agalsidase alfa enzyme replacement therapy [ERT]); 50-64 (n=537; 35.4% male; 74.3% treated); 65-74 (n=137; 32.1% male; 68.6% treated); and ≥75years (n=26; 26.9% male; 50.0% treated). Successive age groups showed higher median age at first symptom and diagnosis. Median alpha-galactosidase A activity, measured as percentage activity of the midpoint of the normal range, was much greater in females than males of all groups except ≥75years (33.4% in females; 27.8% in males). Patients aged ≥75years showed greater values than patients aged 18-49years for median left ventricular mass indexed to height (62.7 vs 42.4g/m(2.7)), mean ventricular wall thickness (15.0 vs 10.0mm) and prevalence of hypertension (57.7% vs 21.8%), and lower median estimated glomerular filtration rate (Modification of Diet in Renal Disease: 65.6 vs 98.5mL/min/1.73m(2)). Larger proportions in the groups aged ≥50 exhibited cardiac and/or cerebrovascular manifestations compared with patients aged 18-49years. The smaller proportion of patients receiving ERT aged ≥75years compared with the younger groups might reflect relatively milder disease burden or physician/patient reluctance to initiate/continue ERT at this age. Further studies are needed to increase knowledge of Fabry disease and ERT in later life.
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Affiliation(s)
- Olivier Lidove
- Department of Internal Medicine-Rheumatology, Hôpital Diaconesses-Croix Saint Simon, Paris, France
| | - Frédéric Barbey
- Center of Molecular Diseases, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Dau-Ming Niu
- Institute of Clinical Medicine, National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Eva Brand
- Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, University Hospital Münster, Münster, Germany
| | - Kathleen Nicholls
- Department of Nephrology, Royal Melbourne Hospital and the University of Melbourne, Victoria, Australia
| | | | - Derralynn A Hughes
- Lysosomal Storage Disorders Unit, Department of Haematology, Royal Free London NHS Foundation Trust and University College London, London, UK.
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Romani I, Borsini W, Nencini P, Morrone A, Ferri L, Frusconi S, Donadio VA, Liguori R, Donati MA, Falconi S, Pracucci G, Inzitari D. De novo Diagnosis of Fabry Disease among Italian Adults with Acute Ischemic Stroke or Transient Ischemic Attack. J Stroke Cerebrovasc Dis 2015; 24:2588-95. [PMID: 26298600 DOI: 10.1016/j.jstrokecerebrovasdis.2015.07.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/21/2015] [Accepted: 07/16/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Cerebrovascular complications are often the first cause of hospitalization in patients with Fabry disease (FD). Screenings for FD among stroke patients have yielded discrepant results, likely as a result of heterogeneous or incomplete assessment. We designed a study to identify FD among adults 60 years of age or younger who were consecutively admitted for acute ischemic stroke or transient ischemic attack (TIA) to a stroke neurology service in Italy. METHODS Patients with first-ever or recurrent events were included, irrespective of gender, risk factors, or stroke type. We screened male patients using α-galactosidase A enzyme assay, and female patients using DNA sequencing. FD was eventually established after a broad multidisciplinary discussion. RESULTS We screened 108 patients (61% males, median age: 48 years); 84% of these patients had stroke. De novo FD diagnosis was established in 3 patients (2.8%; 95% confidence interval, .57-8.18): a 59-year-old man with recurrent lacunar-like strokes and multiple risk factors; a 42-year-old woman with recurrent cryptogenic minor strokes; and a 32-year-old woman with recurrent strokes previously attributed to Behçet's disease. Screened patients were systematically asked for typical FD symptoms; each of the de novo patients reported one or more of the following: episodes of hand/foot pain during fever, angiokeratoma, and family history of heart disease. In all of the patients events were recurrent, and lacunar-like infarcts characterized their brain imaging. CONCLUSIONS Prevalence of FD among nonselected adults 60 years of age or younger with acute ischemic stroke or TIA is not negligible. A systematic search for FD in a stroke setting, using a comprehensive clinical, biochemical, and genetic screening protocol, may be worthwhile.
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Affiliation(s)
- Ilaria Romani
- NEUROFARBA Department, University of Florence, v.le Pieraccini 6, 50139 Florence, Italy.
| | - Walter Borsini
- NEUROFARBA Department, University of Florence, v.le Pieraccini 6, 50139 Florence, Italy
| | - Patrizia Nencini
- Stroke Unit and Neurology, Heart and Vessels Department, Careggi Hospital, l.go Brambilla 3, 50134, Florence, Italy
| | - Amelia Morrone
- NEUROFARBA Department, University of Florence, v.le Pieraccini 6, 50139 Florence, Italy; Paediatric Neurology Unit and Laboratories, Neuroscience Department, Meyer Children's Hospital, v.le Pieraccini 24, Florence, Italy
| | - Lorenzo Ferri
- NEUROFARBA Department, University of Florence, v.le Pieraccini 6, 50139 Florence, Italy
| | - Sabrina Frusconi
- Genetic Diagnostics Unit, Laboratory Department, Careggi Hospital, l.go Brambilla 3, 50134 Florence, Italy
| | - Vincenzo Angelo Donadio
- IRCCS Institute of Neurological Sciences, Bellaria Hospital, v. Altura 3, 40139 Bologna, Italy
| | - Rocco Liguori
- IRCCS Institute of Neurological Sciences, Bellaria Hospital, v. Altura 3, 40139 Bologna, Italy; DIBINEM Department, Alma Mater Studiorum, University of Bologna, v. Foscolo 7, 40123 Bologna, Italy
| | - Maria Alice Donati
- Paediatric Neurology Unit and Laboratories, Neuroscience Department, Meyer Children's Hospital, v.le Pieraccini 24, Florence, Italy
| | - Serena Falconi
- Genetic Diagnostics Unit, Laboratory Department, Careggi Hospital, l.go Brambilla 3, 50134 Florence, Italy
| | - Giovanni Pracucci
- NEUROFARBA Department, University of Florence, v.le Pieraccini 6, 50139 Florence, Italy
| | - Domenico Inzitari
- NEUROFARBA Department, University of Florence, v.le Pieraccini 6, 50139 Florence, Italy; Stroke Unit and Neurology, Heart and Vessels Department, Careggi Hospital, l.go Brambilla 3, 50134, Florence, Italy
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Ashe KM, Budman E, Bangari DS, Siegel CS, Nietupski JB, Wang B, Desnick RJ, Scheule RK, Leonard JP, Cheng SH, Marshall J. Efficacy of Enzyme and Substrate Reduction Therapy with a Novel Antagonist of Glucosylceramide Synthase for Fabry Disease. Mol Med 2015; 21:389-99. [PMID: 25938659 DOI: 10.2119/molmed.2015.00088] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 04/30/2015] [Indexed: 01/11/2023] Open
Abstract
Fabry disease, an X-linked glycosphingolipid storage disorder, is caused by the deficient activity of α-galactosidase A (α-Gal A). This results in the lysosomal accumulation in various cell types of its glycolipid substrates, including globotriaosylceramide (GL-3) and lysoglobotriaosylceramide (globotriaosyl lysosphingolipid, lyso-GL-3), leading to kidney, heart, and cerebrovascular disease. To complement and potentially augment the current standard of care, biweekly infusions of recombinant α-Gal A, the merits of substrate reduction therapy (SRT) by selectively inhibiting glucosylceramide synthase (GCS) were examined. Here, we report the development of a novel, orally available GCS inhibitor (Genz-682452) with pharmacological and safety profiles that have potential for treating Fabry disease. Treating Fabry mice with Genz-682452 resulted in reduced tissue levels of GL-3 and lyso-GL-3 and a delayed loss of the thermal nociceptive response. Greatest improvements were realized when the therapeutic intervention was administered to younger mice before they developed overt pathology. Importantly, as the pharmacologic profiles of α-Gal A and Genz-682452 are different, treating animals with both drugs conferred the greatest efficacy. For example, because Genz-682452, but not α-Gal A, can traverse the blood-brain barrier, levels of accumulated glycosphingolipids were reduced in the brain of Genz-682452-treated but not α-Gal A-treated mice. These results suggest that combining substrate reduction and enzyme replacement may confer both complementary and additive therapeutic benefits in Fabry disease.
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Affiliation(s)
- Karen M Ashe
- Genzyme, a Sanofi Company, Framingham, Massachusetts, United States of America
| | - Eva Budman
- Genzyme, a Sanofi Company, Framingham, Massachusetts, United States of America
| | - Dinesh S Bangari
- Genzyme, a Sanofi Company, Framingham, Massachusetts, United States of America
| | - Craig S Siegel
- Genzyme, a Sanofi Company, Framingham, Massachusetts, United States of America
| | | | - Bing Wang
- Genzyme, a Sanofi Company, Framingham, Massachusetts, United States of America
| | - Robert J Desnick
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Ronald K Scheule
- Genzyme, a Sanofi Company, Framingham, Massachusetts, United States of America
| | - John P Leonard
- Genzyme, a Sanofi Company, Framingham, Massachusetts, United States of America
| | - Seng H Cheng
- Genzyme, a Sanofi Company, Framingham, Massachusetts, United States of America
| | - John Marshall
- Genzyme, a Sanofi Company, Framingham, Massachusetts, United States of America
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Suntjens EB, Smid BE, Biegstraaten M, Dreschler WA, Hollak CEM, Linthorst GE. Hearing loss in adult patients with Fabry disease treated with enzyme replacement therapy. J Inherit Metab Dis 2015; 38:351-8. [PMID: 25395255 DOI: 10.1007/s10545-014-9783-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 10/01/2014] [Accepted: 10/14/2014] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Data on prevalence, natural history, and effect of enzyme replacement therapy (ERT) on hearing loss (HL) in Fabry disease (FD) are scarce. METHODS This is a retrospective study with cross-sectional and longitudinal analyses. Low and high-frequency HL in the Dutch FD cohort was studied in four groups: classical and non-classical FD patients with or without ERT. To study effects of ERT, longitudinal data, corrected for age and gender according to ISO-1999 guidelines, were analyzed with mixed models. RESULTS In the cross-sectional analysis, 107 FD patients (41 males), median age 47.6 years (18.8-80.6) were analyzed. At baseline, i.e., before start of ERT, HL was present in 18 patients (16.8 %), of whom four had bilateral sensorineural HL. HL was more often present in patients with the classical phenotype than non-classical patients (p < 0.01). Likewise, males had more often HL than females. Compared to the general population, FD patients show a median HL of 8.2 dB at low frequencies (p < 0.01) and 29.5 dB at ultra-high frequencies (p < 0.01). Longitudinal analyses (n = 91) revealed that ERT treated patients show a similar rate of decline, not significantly different from healthy controls. CONCLUSION Adult FD patients, especially classical affected males, show impaired hearing. Longitudinal analyses during ERT in these patients demonstrates a decline of HL similar to healthy controls, but HL present before initiation of therapy cannot be reversed. Whether early therapy can prevent hearing loss is unknown.
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Affiliation(s)
- Eefje B Suntjens
- Sphinx-Amsterdam Lysosome Center, Department of Endocrinology and metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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van der Tol L, Sminia ML, Hollak CEM, Biegstraaten M. Cornea verticillata supports a diagnosis of Fabry disease in non-classical phenotypes: results from the Dutch cohort and a systematic review. Br J Ophthalmol 2015; 100:3-8. [DOI: 10.1136/bjophthalmol-2014-306433] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/17/2015] [Indexed: 11/03/2022]
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Altarescu G, Haim S, Elstein D. Angiotensinogen promoter and angiotensinogen II receptor type 1 gene polymorphisms and incidence of ischemic stroke and neurologic phenotype in Fabry disease. Biomarkers 2013; 18:595-600. [DOI: 10.3109/1354750x.2013.836244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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