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Breyer M, Grüner J, Klein A, Finke L, Klug K, Sauer M, Üçeyler N. In vitro characterization of cells derived from a patient with the GLA variant c.376A>G (p.S126G) highlights a non-pathogenic role in Fabry disease. Mol Genet Metab Rep 2024; 38:101029. [PMID: 38469097 PMCID: PMC10926200 DOI: 10.1016/j.ymgmr.2023.101029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 03/13/2024] Open
Abstract
Fabry disease (FD) is a life-limiting disorder characterized by intracellular globotriaosylceramide (Gb3) accumulations. The underlying α-galactosidase A (α-GAL A) deficiency is caused by variants in the gene GLA. Variants of unknown significance (VUS) are frequently found in GLA and challenge clinical management. Here, we investigated a 49-year old man with cryptogenic lacunar cerebral stroke and the chance finding of the VUS S126G, who was sent to our center for diagnosis and initiation of a costly and life-long FD-specific treatment. We combined clinical examination with in vitro investigations of dermal fibroblasts (HDF), induced pluripotent stem cells (iPSC), and iPSC-derived sensory neurons. We analyzed α-GAL A activity in iPSC, Gb3 accumulation in all three cell types, and action potential firing in sensory neurons. Neurological examination and small nerve fiber assessment was normal except for reduced distal skin innervation. S126G iPSC showed normal α-GAL A activity compared to controls and no Gb3 deposits were found in all three cell types. Baseline electrophysiological characteristics of S126G neurons showed no difference compared to healthy controls as investigated by patch-clamp recordings. We pioneer multi-level cellular characterization of the VUS S126G using three cell types derived from a patient and provide further evidence for the benign nature of S126G in GLA, which is of great importance in the management of such cases in clinical practice.
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Affiliation(s)
- Maximilian Breyer
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany
| | - Julia Grüner
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany
| | - Alexandra Klein
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany
| | - Laura Finke
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany
| | - Katharina Klug
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany
| | - Markus Sauer
- Department of Biophysics and Biotechnology, Biocenter, University of Würzburg, 97074 Würzburg, Germany
| | - Nurcan Üçeyler
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany
- Würzburg Fabry Center for Interdisciplinary Therapy (FAZIT), University of Würzburg, 97080 Würzburg, Germany
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Vicente R, Santos I, Coimbra M, Santos J, Santos R, Amoedo M, Pires C. D313Y variant in two related end-stage renal disease patients - Pathogenic or not yet? Nefrologia 2023; 43:636-639. [PMID: 36517364 DOI: 10.1016/j.nefroe.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 01/02/2022] [Indexed: 06/17/2023] Open
Abstract
Fabry disease is a multisystem lysosomal storage disorder caused by mutations in the GLA gene that result in a deficient or absent activity of alpha-galactosidase A. There is a wide spectrum of GLA gene variants, some of which are described as non-pathogenic. The clinical importance of the D313Y variant is still under debate, although in recent years it has been considered as a variant of unknown significance or a benign variant. Despite this prevailing notion, there are multiple case reports of patients with D313Y variant that presented signs and symptoms consistent with FD without any other etiological explanation. In this article, we present two family members with an important renal phenotype and other typical manifestations of FD (white matter lesions and left ventricular hypertrophy) that only had the D313Y variant. These cases suggest that this variant of unknown significance may contribute to the development of common features of FD and should not be undervalued.
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Affiliation(s)
- Rita Vicente
- Nephrology Department, Hospital Espírito Santo de Évora, E.P.E., Évora, Portugal.
| | - Iolanda Santos
- Nephrology Department, Hospital Espírito Santo de Évora, E.P.E., Évora, Portugal
| | - Miguel Coimbra
- Nephrology Department, Hospital Espírito Santo de Évora, E.P.E., Évora, Portugal
| | - Joana Santos
- Nephrology Department, Hospital Espírito Santo de Évora, E.P.E., Évora, Portugal
| | - Ricardo Santos
- Nephrology Department, Hospital Espírito Santo de Évora, E.P.E., Évora, Portugal
| | - Manuel Amoedo
- Nephrology Department, Hospital Espírito Santo de Évora, E.P.E., Évora, Portugal
| | - Carlos Pires
- Nephrology Department, Hospital Espírito Santo de Évora, E.P.E., Évora, Portugal
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Avanesov M, Asgari A, Muschol N, Köhn AF, Tahir E, Adam G, Kirchhof P, Lund G, Cavus E, Patten M. Comparison of classical Fabry and its p.D313Y and p.A143T variants by cardiac T1 mapping, LGE and feature tracking myocardial strain. Sci Rep 2023; 13:5809. [PMID: 37037838 PMCID: PMC10086062 DOI: 10.1038/s41598-023-32464-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 03/28/2023] [Indexed: 04/12/2023] Open
Abstract
Cardiac manifestation of classical Fabry disease (cFD) varies with sex and presence of left ventricular hypertrophy. p.D313Y/p.A143T variants (vFD) represent milder late-onset phenotypes, however, data on vFD are scarce. Patients with FD (cFD = 37;vFD = 14) and 14 healthy controls underwent 1.5 T CMR including Cine, LGE, native T1 mapping(nT1) and myocardial strain(CMR-FT). CMR-FT was assessed using ventricular longitudinal, circumferential, radial (LV-GLS/RV-GLS, LV-GCS/LV-GRS), and atrial longitudinal strain (LA/RATotal, LA/RAConduit, LA/RABooster). In cFD reduced myocardial strain (LV-GLS: -20 ± 4 vs. -24 ± 3%,p = 0.007; LV-GCS: -20 ± 4 vs. -26 ± 4%,p = 0.002, LA Total -GLS: 29 ± 10 vs. 37 ± 6%,p = 0.007; LA Conduit -GLS: 15 ± 10 vs. 23 ± 5%,p = 0.003) and nT1 values (951 ± 51 ms vs. 1036 ± 20 ms, p < 0.001) were observed compared to controls. In vFD findings were comparable to controls. LV-GCS provided the closest Area under the curve (AUC) to nT1 (0.84 vs. 0.92, p > 0.05) for discrimination of cFD versus controls. Significantly lower LV-GLS/LV-GCS was found in male compared to female cFD (-19 ± 4 vs. -22 ± 4%, p = 0.03). In six non-hypertrophied female cFD with normal nT1 LATotal -GLS was the only discriminating parameter with an accuracy of 86%. LV-GLS, LV-GCS and LATotal -GLS can detect impaired cardiac mechanics of cFD besides nT1. LATotal -GLS might identify non-hypertrophied female cFD. Variants p.D313Y/p.A143T did not reveal cardiac involvement by multiparametric CMR.
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Affiliation(s)
- Maxim Avanesov
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Anahid Asgari
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Nicole Muschol
- Department of Pediatrics, International Center for Lysosomal Disorders (ICLD), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Friederike Köhn
- Department of Pediatrics, International Center for Lysosomal Disorders (ICLD), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, University Hospital Hamburg Eppendorf, 20246, Hamburg, Germany
- Deutsches Zentrum Für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany
| | - Gunnar Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Ersin Cavus
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, University Hospital Hamburg Eppendorf, 20246, Hamburg, Germany.
- Deutsches Zentrum Für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany.
| | - Monica Patten
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, University Hospital Hamburg Eppendorf, 20246, Hamburg, Germany
- Deutsches Zentrum Für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany
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Strunk D, Becker J, Veltkamp R, Meuth SG, Bauer P, Böttcher T, Rolfs A, Schwitalla JC, Kraemer M. How relevant are cerebral white matter lesions in the D313Y variant of the α-galactosidase A gene? Neurological, cardiological, laboratory, and MRI data of 21 patients within a follow-up of 3 years. Neurol Sci 2023; 44:1375-1381. [PMID: 36456878 DOI: 10.1007/s10072-022-06533-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/24/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Fabry disease is an inherited metabolic disorder with various symptoms. Neurological manifestations are small fiber neuropathy, cerebral white matter lesions (WML), megadolicho basilar artery, and stroke. The relevance of the D313Y variant in the galactosidase alpha gene is controversially discussed. OBJECTIVES We aimed at elucidating the implications of this differential diagnosis of multiple sclerosis (MS), focussing on the analysis of WML over time and correlations with other markers. METHODS We reviewed retrospectively the clinical, laboratory, and magnetic resonance imaging data of 21 carriers of the D313Y variant at a single German outpatient clinic for MS between 2004 and 2021. RESULTS In our cohort (15 females, 6 males), mean age at diagnosis was 44.1 ± 16.3 years, and mean follow-up duration was 3.1 ± 3.9 years. WML were rated on both, the Fazekas scale and the age-related white matter changes rating scale, and were of variable interindividual extent. Follow-up imaging showed virtually no progress. WML did not correlate with the severity of clinical findings or lysoGb3 levels. Symptomatic carriers of the variant are characterized by an almost complete lack of internal organ manifestations and laboratory findings, usually associated with Fabry disease. CONCLUSION WML in carriers of the D313Y variant do not seem to be suitable for assessing or predicting the (para-) clinical status. Concerning MS patients, the variant and its clinical signs can be a differential diagnosis, but also a co-factor. Imaging and cerebrospinal fluid findings facilitate the distinction between both entities.
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Affiliation(s)
- Daniel Strunk
- Department of Neurology, Alfried Krupp Krankenhaus Essen, Alfried-Krupp-Straße 21, 45131, Essen, Germany.
| | - Jana Becker
- Department of Neurology, Alfried Krupp Krankenhaus Essen, Alfried-Krupp-Straße 21, 45131, Essen, Germany
| | - Roland Veltkamp
- Department of Neurology, Alfried Krupp Krankenhaus Essen, Alfried-Krupp-Straße 21, 45131, Essen, Germany
- Department of Brain Sciences, Imperial College London, London, UK
| | - Sven G Meuth
- Department of Neurology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Tobias Böttcher
- CENTOGENE GmbH, Rostock, Germany
- Medical Service Center of Johanna-Odebrecht-Stiftung, Greifswald, Germany
| | - Arndt Rolfs
- Arcenus Diagnostics, Hoboken, NJ, 07030, USA
| | | | - Markus Kraemer
- Department of Neurology, Alfried Krupp Krankenhaus Essen, Alfried-Krupp-Straße 21, 45131, Essen, Germany
- Department of Neurology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Grasso D, Galderisi S, Santucci A, Bernini A. Pharmacological Chaperones and Protein Conformational Diseases: Approaches of Computational Structural Biology. Int J Mol Sci 2023; 24:ijms24065819. [PMID: 36982893 PMCID: PMC10054308 DOI: 10.3390/ijms24065819] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Whenever a protein fails to fold into its native structure, a profound detrimental effect is likely to occur, and a disease is often developed. Protein conformational disorders arise when proteins adopt abnormal conformations due to a pathological gene variant that turns into gain/loss of function or improper localization/degradation. Pharmacological chaperones are small molecules restoring the correct folding of a protein suitable for treating conformational diseases. Small molecules like these bind poorly folded proteins similarly to physiological chaperones, bridging non-covalent interactions (hydrogen bonds, electrostatic interactions, and van der Waals contacts) loosened or lost due to mutations. Pharmacological chaperone development involves, among other things, structural biology investigation of the target protein and its misfolding and refolding. Such research can take advantage of computational methods at many stages. Here, we present an up-to-date review of the computational structural biology tools and approaches regarding protein stability evaluation, binding pocket discovery and druggability, drug repurposing, and virtual ligand screening. The tools are presented as organized in an ideal workflow oriented at pharmacological chaperones' rational design, also with the treatment of rare diseases in mind.
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Affiliation(s)
- Daniela Grasso
- Department of Biotechnology, Chemistry, and Pharmacy, University of Siena, 53100 Siena, Italy
| | - Silvia Galderisi
- Department of Biotechnology, Chemistry, and Pharmacy, University of Siena, 53100 Siena, Italy
| | - Annalisa Santucci
- Department of Biotechnology, Chemistry, and Pharmacy, University of Siena, 53100 Siena, Italy
| | - Andrea Bernini
- Department of Biotechnology, Chemistry, and Pharmacy, University of Siena, 53100 Siena, Italy
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Fingrova Z, Havranek S, Sknouril L, Bulava A, Vancura V, Chovanec M, Dedek V, Curila K, Skala T, Jäger J, Kluh T, Dostalova G, Germain DP, Linhart A. Screening of Fabry disease in patients with an implanted permanent pacemaker. Int J Cardiol 2023; 372:71-5. [PMID: 36473604 DOI: 10.1016/j.ijcard.2022.11.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/14/2022] [Accepted: 11/29/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Anderson-Fabry disease (AFD) is an X-linked inherited lysosomal disease caused by a defect in the gene encoding lysosomal enzyme α-galactosidase A (GLA). Atrio-ventricular (AV) nodal conduction defects and sinus node dysfunction are common complications of the disease. It is not fully elucidated how frequently AFD is responsible for acquired AV block or sinus node dysfunction and if some AFD patients could manifest primarily with spontaneous bradycardia in general population. The purpose of study was to evaluate the prevalence of AFD in male patients with implanted permanent pacemaker (PM). METHODS The prospective multicentric screening in consecutive male patients between 35 and 65 years with implanted PM for acquired third- or second- degree type 2 AV block or symptomatic second- degree type 1 AV block or sinus node dysfunction was performed. RESULTS A total of 484 patients (mean age 54 ± 12 years at time of PM implantation) were enrolled to the screening in 12 local sites in Czech Republic. Out of all patients, negative result was found in 481 (99%) subjects. In 3 cases, a GLA variant was found, classified as benign: p.Asp313Tyr, p.D313Y). Pathogenic GLA variants (classical or non-classical form) or variants of unclear significance were not detected. CONCLUSION The prevalence of pathogenic variants causing AFD in a general population sample with implanted permanent PM for AV conduction defects or sinus node dysfunction seems to be low. Our findings do not advocate a routine screening for AFD in all adult males with clinically significant bradycardia.
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Palaiodimou L, Stefanou MI, Bakola E, Papadopoulou M, Kokotis P, Vrettou AR, Kapsia E, Petras D, Anastasakis A, Xifaras N, Karachaliou E, Touloumi G, Vlachopoulos C, Boletis IN, Giannopoulos S, Tsivgoulis G, Zompola C. D313Y Variant in Fabry Disease: A Systematic Review and Meta-analysis. Neurology 2022; 99:e2188-e2200. [PMID: 36344272 DOI: 10.1212/wnl.0000000000201102] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/27/2022] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is accumulating evidence in the literature indicating a strong correlation between Fabry disease (FD) phenotypes and specific sequence variations in the Galactosidase Alpha (GLA) gene. Among them, the potential pathogenicity and clinical relevance of D313Y variation in patients with FD remain debated. METHODS We performed a systematic review and meta-analysis of studies reporting D313Y as single occurring variant in the GLA gene and sought to evaluate (1) the prevalence of D313Y variation in different populations with or without clinical manifestations of FD, (2) the clinical FD phenotype in D313Y-positive patients, and (3) the proportion of D313Y-positive patients presenting abnormal laboratory findings (alpha-galactosidase-A deficiency or globotriaosylceramide accumulation). RESULTS Forty cohorts comprising 211 individuals with D313Y variation among 42,723 participants with available GLA gene-sequencing data were included. Patients highly suspected for FD had a higher prevalence of D313Y variation (4.9%, 95% CI 1.6%-9.9%; I2 = 95.5%) compared with the general population (0%, 95% CI 0%-0.1%; I2 = 1.9%; p = 0.004). The prevalence of D313Y variation was 0.6% (95% CI 0.3%-1%; I2 = 74.1%), 0.4% (95% CI 0.2%-0.7%; I2 = 0%), and 0.3% (95% CI 0.2%-0.4%; I2 = 0%) in patients presenting with neurologic, cardiac, or renal manifestations, respectively. D313Y was associated with a milder, late-onset FD phenotype, as indicated by the mean patient age of 51 years (95% CI 44-59; I2 = 94%) and the evidence of alpha-galactosidase A deficiency and globotriaosylceramide accumulation in 26.7% (95% CI 15.3%-40%; I2 = 34%) and 16.2% (95% CI 8%-26.4%; I2 = 35%) of cases, respectively. D313Y-positive patients displayed predominantly neurologic FD manifestations (58.1%, 95% CI 37.7%-77.1%; I2 = 78%), with central and peripheral nervous system (CNS/PNS) involvement noted in 28.2% (95% CI 15.4%-43.2%; I2 = 51%) and 28.5% (95% CI 17.8%-40.5%; I2 = 61%) of cases, respectively. DISCUSSION D313Y variation seems to correlate with an atypical, mild late-onset phenotype with predominantly neurologic FD manifestations. Monitoring for CNS/PNS involvement is thus paramount to identify D313Y-positive patients with latent or early-FD pathology, which may qualify for enzyme-replacement therapy or chaperone treatment.
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Affiliation(s)
- Lina Palaiodimou
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Maria-Ioanna Stefanou
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Eleni Bakola
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Marianna Papadopoulou
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Panagiotis Kokotis
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Agathi-Rosa Vrettou
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Eleni Kapsia
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Dimitrios Petras
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Aris Anastasakis
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Nikolaos Xifaras
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Eleni Karachaliou
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Giota Touloumi
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Charalambos Vlachopoulos
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Ioannis N Boletis
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Sotirios Giannopoulos
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
| | - Georgios Tsivgoulis
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN.
| | - Christina Zompola
- From the Second Department of Neurology (L.P., M.-I.S., E.B., M.P., N.X., Eleni Karachaliou, S.G., Georgios Tsivgoulis, C.Z.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; First Department of Neurology (P.K.), "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Second Department of Cardiology (A.-R.V.), National and Kapodistrian University of Athens, School of Medicine, "Attikon" Hospital, Athens, Greece; Clinic of Nephrology and Renal Transplantation (Eleni Kapsia, I.N.B.), Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece; Nephrology Department (D.P.), Hippokration General Hospital, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases (A.A.), Onassis Cardiac Surgery Center, Athens, Greece; Department of Hygiene (Giota Touloumi), Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; First Department of Cardiology (C.V.), Hippokration Hospital, University of Athens, Athens, Greece; and Department of Neurology (Georgios Tsivgoulis), University of Tennessee Health Science Center, Memphis, TN
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Monte MA, Veroux M, Rodolico MS, Losi V, Di Pino L, Bella R, Lanza G, Monte IP. Fabry's Disease: The Utility of a Multidisciplinary Screening Approach. Life (Basel) 2022; 12:life12050623. [PMID: 35629291 PMCID: PMC9146284 DOI: 10.3390/life12050623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/10/2022] [Accepted: 04/20/2022] [Indexed: 02/07/2023] Open
Abstract
(1) Background: As a lysosomal storage disorder, Fabry’s disease (FD) shows variable clinical manifestations. We applied our multidisciplinary approach to identify any organ damage in a sample of adult patients with different pathogenic variants. (2) Methods: 49 participants (mean age 44.3 ± 14.2 years; 37 females), underwent a multidimensional clinical and instrumental assessment. (3) Results: At diagnosis, mean enzymatic activity was 5.2 ± 4.6 nM/mL/h in females and 1.4 ± 0.5 nM/mL/h in males (normal values > 3.0), whereas globotriaosylsphingosine was 2.3 ± 2.1 nM/L in females and 28.7 ± 3.5 nM/L in males (normal values < 2.0). Overall, cardiovascular, neurological, and audiological systems were the most involved, regardless of the variant detected. Patients with classic variants (10) showed typical multiorgan involvement and, in some cases, prevalent organ damage (cardiovascular, neurological, renal, and ocular). Those with late-onset variants (39) exhibited lower occurrence of multiorgan impairment, although some of them affected the cardiovascular and neurological systems more. In patients with lower enzymatic activity, the most frequent involvement was neurological, followed by peripheral vascular disease. (4) Conclusions: FD patients exhibited wide phenotypic variability, even at single-organ level, likely due to the individual genetic mutation, although other factors may contribute. Compared to the conventional management, a multidisciplinary approach, as that prompted at our Center, allows one to achieve early clinical detection and management.
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Affiliation(s)
- Marco Angelo Monte
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (M.A.M.); (V.L.); (L.D.P.); (G.L.)
| | - Massimiliano Veroux
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (M.V.); (R.B.)
| | | | - Valentina Losi
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (M.A.M.); (V.L.); (L.D.P.); (G.L.)
| | - Luigi Di Pino
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (M.A.M.); (V.L.); (L.D.P.); (G.L.)
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (M.V.); (R.B.)
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (M.A.M.); (V.L.); (L.D.P.); (G.L.)
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy
| | - Ines Paola Monte
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (M.A.M.); (V.L.); (L.D.P.); (G.L.)
- Correspondence:
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Lackova A, Beetz C, Oppermann S, Bauer P, Pavelekova P, Lorincova T, Ostrozovicova M, Kulcsarova K, Cobejova J, Cobej M, Levicka P, Liesenerova S, Sendekova D, Sukovska V, Gdovinova Z, Han V, Rizig M, Houlden H, Skorvanek M. Prevalence of Fabry Disease among Patients with Parkinson's Disease. Parkinsons Dis 2022; 2022:1014950. [PMID: 35111290 PMCID: PMC8803460 DOI: 10.1155/2022/1014950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/08/2022] [Accepted: 01/11/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND An increased prevalence of Parkinson's disease (PD) disease has been previously reported in subjects with Fabry disease (FD) carrying alpha-galactosidase (GLA) mutations and their first-line relatives. Moreover, decreased alpha-galactosidase A (AGLA) enzymatic activity has been reported among cases with PD compared to controls. OBJECTIVE The aim of our study was to determine the prevalence of FD among patients with PD. METHODS We recruited 236 consecutive patients with PD from February 2018 to December 2020. Clinical and sociodemographic data, including the MDS-UPDRS-III scores and HY stage (the Hoehn and Yahr scale), were collected, and in-depth phenotyping was performed in subjects with identified GLA variants. A multistep approach, including standard determination of AGLA activity and LysoGb3 in males, and next-generation based GLA sequencing in all females and males with abnormal AGLA levels was performed in a routine diagnostic setting. RESULTS The mean age of our patients was 68.9 ± 8.9 years, 130 were men (55.1%), and the mean disease duration was 7.77 ± 5.35 years. Among 130 men, AGLA levels were low in 20 patients (15%), and subsequent Lyso-Gb3 testing showed values within the reference range for all tested subjects. In 126 subsequently genetically tested patients, four heterozygous p.(Asp313Tyr) GLA variants (3.2%, MAF 0.016) were identified; all were females. None of the 4 GLA variant carriers identified had any clinical manifestation suggestive of FD. CONCLUSIONS The results of this study suggest a possible relationship between FD and PD in a small proportion of cases. Nevertheless, the GLA variant found in our cohort is classified as a variant of unknown significance. Therefore, its pathogenic causative role in the context of PD needs further elucidation, and these findings should be interpreted with caution.
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Affiliation(s)
- Alexandra Lackova
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
- Department of Neurology, University Hospital of L. Pasteur, Košice, Slovakia
| | | | | | | | - Petra Pavelekova
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
- Department of Neurology, University Hospital of L. Pasteur, Košice, Slovakia
| | - Tatiana Lorincova
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
| | - Miriam Ostrozovicova
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
- Department of Neurology, University Hospital of L. Pasteur, Košice, Slovakia
| | - Kristina Kulcsarova
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
- Department of Neurology, University Hospital of L. Pasteur, Košice, Slovakia
| | - Jana Cobejova
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
| | - Martin Cobej
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
| | - Petra Levicka
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
| | - Simona Liesenerova
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
| | - Daniela Sendekova
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
| | - Viktoria Sukovska
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
| | - Zuzana Gdovinova
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
- Department of Neurology, University Hospital of L. Pasteur, Košice, Slovakia
| | - Vladimir Han
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
- Department of Neurology, University Hospital of L. Pasteur, Košice, Slovakia
| | - Mie Rizig
- University College London, Institute of Neurology, Department of Neuromuscular Disorders, Queen Square, WC1N 3BG London, UK
| | - Henry Houlden
- University College London, Institute of Neurology, Department of Neuromuscular Disorders, Queen Square, WC1N 3BG London, UK
| | - Matej Skorvanek
- Department of Neurology, University of Pavol Jozef Šafárik, Košice, Slovakia
- Department of Neurology, University Hospital of L. Pasteur, Košice, Slovakia
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Vicente R, Santos I, Coimbra M, Santos J, Santos R, Amoedo M, Pires C. D313Y variant in two related end-stage renal disease patients – Pathogenic or not yet? Nefrologia 2022. [DOI: 10.1016/j.nefro.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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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: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Tang ASO, Wong QY, Pao Lin Ting I, Selvesten P, Yeo ST, Chew LP, Fam TL, Tan CHH. First 2 Fabry Cases with Novel Mutation and Their Associated Clusters in Malaysia. Am J Case Rep 2021; 22:e932923. [PMID: 34354036 PMCID: PMC8351246 DOI: 10.12659/ajcr.932923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND No cases of Fabry disease (FD) have been reported thus far in Malaysia. We aimed to report the demographic characteristics, clinical manifestations, molecular results, and treatment outcomes of 2 FD cases. This study was a retrospective review of 2 family clusters of FD on follow-up in Sarawak, Malaysia. CASE REPORT Two index patients were confirmed to have FD. Index patient 1, who had nephrotic-range proteinuria and cornea verticillata, carried a variant within exon 4 of the GLA gene: c.610 T>C (p.Trp204Arg). Agalsidase beta (Fabrazyme®) enzyme replacement therapy was initiated, with the absence of neutralizing antibody after 24 months. No hypersensitivity or adverse reactions were reported. The patient's proteinuria and renal function remained stable. Other family members who carried the same mutation were asymptomatic. Index patient 2, who had residual activity of alpha-galactosidase A and a normal globotriaosylsphingosine level, carried a novel GLA mutation of c.548-5T>A. He was diagnosed with end-stage renal disease on regular dialysis and had nonspecific headache with 1 episode of seizure a few years prior to FD genetic screening. One brother had chronic neuropathic pain but refused further investigations. Other family members who had the same mutation were asymptomatic. This mutation has never been reported in literature, and its pathogenicity warrants further studies. CONCLUSIONS It is of utmost importance to increase awareness of FD among clinicians, so that appropriate screening may be done to determine its true prevalence and prompt treatment can be initiated early.
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Affiliation(s)
- Andy Sing Ong Tang
- Department of Internal Medicine, Miri Hospital, Ministry of Health, Miri, Sarawak, Malaysia
| | - Qi Ying Wong
- Department of Internal Medicine, Miri Hospital, Ministry of Health, Miri, Sarawak, Malaysia
| | - Ingrid Pao Lin Ting
- Department of Internal Medicine, Miri Hospital, Ministry of Health, Miri, Sarawak, Malaysia
| | - Panting Selvesten
- Department of Internal Medicine, Miri Hospital, Ministry of Health, Miri, Sarawak, Malaysia
| | - Siaw Tze Yeo
- Department of Internal Medicine, Miri Hospital, Ministry of Health, Miri, Sarawak, Malaysia
| | - Lee Ping Chew
- Haematology Unit, Department of Internal Medicine, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia
| | - Tem Lom Fam
- Department of Internal Medicine, Miri Hospital, Ministry of Health, Miri, Sarawak, Malaysia
| | - Clare Hui Hong Tan
- Nephrology Unit, Department of Internal Medicine, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia
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von Cossel K, Muschol N, Friedrich RE, Glatzel M, Ammer L, Lohmöller B, Bendszus M, Mautner VF, Godel T. Assessment of small fiber neuropathy in patients carrying the non-classical Fabry variant p.D313Y. Muscle Nerve 2021; 63:745-750. [PMID: 33543778 DOI: 10.1002/mus.27196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The pathophysiological significance of the Fabry-related, non-classical variant p.D313Y still remains to be solved. This study assesses the involvement of the peripheral nervous system with respect to small fiber neuropathy and neuropathic pain in female patients carrying p.D313Y. METHODS This study examined nine females carrying the Fabry-related p.D313Y variant by obtaining skin punch biopsies above the right lateral malleolus. Intraepidermal nerve fiber density was determined for each patient and compared to reference values matched for the patient's decade of life and sex. Moreover, each patient was characterized by a detailed neurological examination and by pain assessment via questionnaire. RESULTS Compared to sex-matched lower fifth percentile reference values per decade, intraepidermal nerve fiber density was decreased in seven out of nine patients. Four patients reported acral paresthesias and neuropathic pain with an average visual analogue scale score of 7 out of 10 points. Two patients experienced acute pain crises. Six out of seven patients diagnosed with small fiber neuropathy had a their medical history of hypo- and/or hyperhidrosis. DISCUSSION The diagnosis of small fiber neuropathy was made in seven out of nine females carrying the non-classical variant p.D313Y. Moreover, neuropathic pain and symptoms indicative of autonomic nervous system dysfunction seem to be common findings that may be of clinical significance and may warrant therapeutic intervention.
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Affiliation(s)
- Katharina von Cossel
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicole Muschol
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Reinhard E Friedrich
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Glatzel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Luise Ammer
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Lohmöller
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Heidelberg, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Godel
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Heidelberg, Germany
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14
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Godel T, von Cossel K, Friedrich RE, Glatzel M, Canaan-Kühl S, Duning T, Kronlage M, Heiland S, Bendszus M, Muschol N, Mautner VF. Assessment of Peripheral Nervous System Alterations in Patients with the Fabry Related GLA-Variant p.A143T. Diagnostics (Basel) 2020; 10:diagnostics10121027. [PMID: 33266233 PMCID: PMC7760340 DOI: 10.3390/diagnostics10121027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/23/2020] [Accepted: 11/28/2020] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study is to examine alterations of the peripheral nervous system (PNS) in oligo-symptomatic patients carrying the Fabry related GLA-gene variant p.A143T by Magnetic Resonance Neurography (MRN) and skin biopsy. This prospective study assessed dorsal root ganglia (DRG) volume L3 to S2, vascular permeability of the DRG L5, S1, and the spinal nerve L5 in five patients carrying p.A143T in comparison to patients with classical Fabry mutations and healthy controls. Moreover, skin punch biopsies above the lateral malleolus of the right foot were obtained in four patients and intraepidermal nerve fiber density (IENFD) was counted individually. Compared to controls, DRG volumes of p.A143T patients were enlarged by 30% (L3, p < 0.05), 35% (L4, p < 0.05), 29% (L5, p = 0.15), 36% (S1, p < 0.01), and 18% (S2, p < 0.05), but less pronounced compared to patients carrying a classical Fabry mutation. Compared to healthy controls, vascular permeability was decreased by 40% (L5 right), 49% (L5 left), 48% (S1 right), and 49% (S1) (p < 0.01–p < 0.001), but non-significant less than patients carrying a classical Fabry mutation. Compared to sex-matched 5% lower normative reference values per decade, IENFD was decreased in three of four patients. MRN and determination of IENFD is able to detect early alteration of the PNS segment in oligo-symptomatic patients with the disease-modifying GLA-variant p.A143T on an individual basis. This procedure might also help in further GLA-variants of uncertain significance for early identification of patients with single major organ manifestation.
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Affiliation(s)
- Tim Godel
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; (M.K.); (S.H.); (M.B.)
- Correspondence: ; Tel.: +49-6221-5634791
| | - Katharina von Cossel
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (K.v.C.); (N.M.)
| | - Reinhard E. Friedrich
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany;
| | - Markus Glatzel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany;
| | - Sima Canaan-Kühl
- Division of Nephrology and Intensive Care Medicine, CCM, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany;
| | - Thomas Duning
- Department of Neurology, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany;
| | - Moritz Kronlage
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; (M.K.); (S.H.); (M.B.)
| | - Sabine Heiland
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; (M.K.); (S.H.); (M.B.)
| | - Martin Bendszus
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; (M.K.); (S.H.); (M.B.)
| | - Nicole Muschol
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; (K.v.C.); (N.M.)
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany;
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15
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Becherucci F, Landini S, Cirillo L, Mazzinghi B, Romagnani P. Look Alike, Sound Alike: Phenocopies in Steroid-Resistant Nephrotic Syndrome. Int J Environ Res Public Health 2020; 17:E8363. [PMID: 33198123 PMCID: PMC7696007 DOI: 10.3390/ijerph17228363] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/30/2020] [Accepted: 11/10/2020] [Indexed: 12/11/2022]
Abstract
Steroid-resistant nephrotic syndrome (SRNS) is a clinical picture defined by the lack of response to standard steroid treatment, frequently progressing toward end-stage kidney disease. The genetic basis of SRNS has been thoroughly explored since the end of the 1990s and especially with the advent of next-generation sequencing. Genetic forms represent about 30% of cases of SRNS. However, recent evidence supports the hypothesis that "phenocopies" could account for a non-negligible fraction of SRNS patients who are currently classified as non-genetic, paving the way for a more comprehensive understanding of the genetic background of the disease. The identification of phenocopies is mandatory in order to provide patients with appropriate clinical management and to inform therapy. Extended genetic testing including phenocopy genes, coupled with reverse phenotyping, is recommended for all young patients with SRNS to avoid unnecessary and potentially harmful diagnostic procedures and treatment, and for the reclassification of the disease. The aim of this work is to review the main steps of the evolution of genetic testing in SRNS, demonstrating how a paradigm shifting from "forward" to "reverse" genetics could significantly improve the identification of the molecular mechanisms of the disease, as well as the overall clinical management of affected patients.
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Affiliation(s)
- Francesca Becherucci
- Pediatric Nephrology and Dialysis Unit, Meyer Children’s Hospital, Viale Pieraccini 24, 50139 Florence, Italy; (L.C.); (B.M.); (P.R.)
| | - Samuela Landini
- Department of Biomedical, Experimental and Clinical Science “Mario Serio”, University of Florence, Viale Morgagni 50, 50134 Florence, Italy;
| | - Luigi Cirillo
- Pediatric Nephrology and Dialysis Unit, Meyer Children’s Hospital, Viale Pieraccini 24, 50139 Florence, Italy; (L.C.); (B.M.); (P.R.)
- Department of Biomedical, Experimental and Clinical Science “Mario Serio”, University of Florence, Viale Morgagni 50, 50134 Florence, Italy;
| | - Benedetta Mazzinghi
- Pediatric Nephrology and Dialysis Unit, Meyer Children’s Hospital, Viale Pieraccini 24, 50139 Florence, Italy; (L.C.); (B.M.); (P.R.)
| | - Paola Romagnani
- Pediatric Nephrology and Dialysis Unit, Meyer Children’s Hospital, Viale Pieraccini 24, 50139 Florence, Italy; (L.C.); (B.M.); (P.R.)
- Department of Biomedical, Experimental and Clinical Science “Mario Serio”, University of Florence, Viale Morgagni 50, 50134 Florence, Italy;
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16
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Rickert V, Wagenhäuser L, Nordbeck P, Wanner C, Sommer C, Rost S, Üçeyler N. Stratification of Fabry mutations in clinical practice: a closer look at α-galactosidase A-3D structure. J Intern Med 2020; 288:593-604. [PMID: 32583479 DOI: 10.1111/joim.13125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/25/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Fabry disease (FD) is an X-linked lysosomal storage and multi-system disorder due to mutations in the α-galactosidase A (α-GalA) gene. We investigated the impact of individual amino acid exchanges in the α-GalA 3D-structure on the clinical phenotype of FD patients. PATIENTS AND METHODS We enrolled 80 adult FD patients with α-GalA missense mutations and stratified them into three groups based on the amino acid exchange location in the α-GalA 3D-structure: patients with active site mutations, buried mutations and other mutations. Patient subgroups were deep phenotyped for clinical and laboratory parameters and FD-specific treatment. RESULTS Patients with active site or buried mutations showed a severe phenotype with multi-organ involvement and early disease manifestation. Patients with other mutations had a milder phenotype with less organ impairment and later disease onset. α-GalA activity was lower in patients with active site or buried mutations than in those with other mutations (P < 0.01 in men; P < 0.05 in women) whilst lyso-Gb3 levels were higher (P < 0.01 in men; <0.05 in women). CONCLUSIONS The type of amino acid exchange location in the α-GalA 3D-structure determines disease severity and temporal course of symptom onset. Patient stratification using this parameter may become a useful tool in the management of FD patients.
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Affiliation(s)
- V Rickert
- From the, Department of Neurology, University of Würzburg, Würzburg, Germany
| | - L Wagenhäuser
- From the, Department of Neurology, University of Würzburg, Würzburg, Germany
| | - P Nordbeck
- Fabry Centre for Interdisciplinary Therapy Würzburg (FAZIT), University of Würzburg, Würzburg, Germany.,Department of Internal Medicine, Division of Cardiology, University of Würzburg, Würzburg, Germany
| | - C Wanner
- Fabry Centre for Interdisciplinary Therapy Würzburg (FAZIT), University of Würzburg, Würzburg, Germany.,Department of Internal Medicine, Division of Nephrology, University of Würzburg, Würzburg, Germany
| | - C Sommer
- From the, Department of Neurology, University of Würzburg, Würzburg, Germany.,Fabry Centre for Interdisciplinary Therapy Würzburg (FAZIT), University of Würzburg, Würzburg, Germany
| | - S Rost
- Institute of Human Genetics, University of Würzburg, Würzburg, Germany
| | - N Üçeyler
- From the, Department of Neurology, University of Würzburg, Würzburg, Germany.,Fabry Centre for Interdisciplinary Therapy Würzburg (FAZIT), University of Würzburg, Würzburg, Germany
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17
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Effraimidis G, Rasmussen ÅK, Bundgaard H, Sørensen SS, Feldt-Rasmussen U. Is the alpha-galactosidase A variant p.Asp313Tyr (p.D313Y) pathogenic for Fabry disease? A systematic review. J Inherit Metab Dis 2020; 43:922-933. [PMID: 32246457 DOI: 10.1002/jimd.12240] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/13/2020] [Accepted: 03/30/2020] [Indexed: 12/21/2022]
Abstract
The identification of pathogenic GLA variants plays a central role in the establishment of a definite Fabry disease (FD) diagnosis. We aimed to review and interpret the published data on the p.Asp313Tyr (p.D313Y) variant pathogenicity and clinical relevance. We performed a systematic review of peer-reviewed publications and case-reports on individuals and populations harbouring the p.Asp313Tyr variant. Overall, 35 studies were included in this review. We collected data regarding the clinical manifestations, alpha-galactosidase A enzyme activity, levels of the biomarkers globotriaosylceramide (Gb3 ) and sphingosine-globotriaosylceramide (lyso-Gb3 ) and histological findings of p.Asp313Tyr carriers. The prevalence of p.Asp313Tyr in populations at risk for FD (kidney, heart, neurologic disorders, or symptomatic populations) was calculated. We found high residual enzyme activity, low frequency of clinical features specific for FD, non-elevated lysoGb3 /Gb3 concentrations and lack of intracellular Gb3 accumulation in biopsies in the p.Asp313Tyr carriers. The prevalence of the variant in populations at risk for FD was comparable to the reported frequency in the general population. A possible higher frequency was only observed in neurologic disorders. p.Asp313Tyr can be classified as neutral or variant of unknown significance. Further investigations will be helpful to clarify a possible association between the variant and manifestations in the brain vessels.
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Affiliation(s)
- Grigoris Effraimidis
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Åse K Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, The Capital Region's Unit of Inherited Cardiac Diseases, Faculty of Health and Medical Sciences, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Søren S Sørensen
- Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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18
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Abstract
Podocytopathies are kidney diseases in which direct or indirect podocyte injury drives proteinuria or nephrotic syndrome. In children and young adults, genetic variants in >50 podocyte-expressed genes, syndromal non-podocyte-specific genes and phenocopies with other underlying genetic abnormalities cause podocytopathies associated with steroid-resistant nephrotic syndrome or severe proteinuria. A variety of genetic variants likely contribute to disease development. Among genes with non-Mendelian inheritance, variants in APOL1 have the largest effect size. In addition to genetic variants, environmental triggers such as immune-related, infection-related, toxic and haemodynamic factors and obesity are also important causes of podocyte injury and frequently combine to cause various degrees of proteinuria in children and adults. Typical manifestations on kidney biopsy are minimal change lesions and focal segmental glomerulosclerosis lesions. Standard treatment for primary podocytopathies manifesting with focal segmental glomerulosclerosis lesions includes glucocorticoids and other immunosuppressive drugs; individuals not responding with a resolution of proteinuria have a poor renal prognosis. Renin-angiotensin system antagonists help to control proteinuria and slow the progression of fibrosis. Symptomatic management may include the use of diuretics, statins, infection prophylaxis and anticoagulation. This Primer discusses a shift in paradigm from patient stratification based on kidney biopsy findings towards personalized management based on clinical, morphological and genetic data as well as pathophysiological understanding.
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19
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Zompola C, Palaiodimou L, Kokotis P, Papadopoulou M, Theodorou A, Sabanis N, Theodoroula E, Papathanasiou M, Tsivgoulis G, Chroni E. The mutation D313Y may be associated with nervous system manifestations in Fabry disease. J Neurol Sci 2020; 412:116757. [PMID: 32109691 DOI: 10.1016/j.jns.2020.116757] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 02/17/2020] [Accepted: 02/21/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Christina Zompola
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece
| | - Lina Palaiodimou
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece.
| | - Panagiotis Kokotis
- First Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Aeginitio Hospital, Athens, Greece
| | | | - Aikaterini Theodorou
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece
| | - Nikolaos Sabanis
- Nephrology Department, General Hospital of Livadia, Livadia, Greece
| | - Efterpi Theodoroula
- Department of Neurology, School of Medicine, University of Patras, Rio-Patras, Greece
| | - Matilda Papathanasiou
- Second Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Elisabeth Chroni
- Department of Neurology, School of Medicine, University of Patras, Rio-Patras, Greece
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20
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Balendran S, Oliva P, Sansen S, Mechtler TP, Streubel B, Cobos PN, Lukacs Z, Kasper DC. Diagnostic strategy for females suspected of Fabry disease. Clin Genet 2020; 97:655-660. [PMID: 31860127 DOI: 10.1111/cge.13694] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/12/2019] [Accepted: 12/06/2019] [Indexed: 12/01/2022]
Abstract
A total of 11 948 females suspicious of Fabry disease were tested by a combined biochemical and genetic approach. The enzyme activity, together with the concentration of lyso-GL-3 (lyso-Gb3) biomarker in dried blood spots (DBS), substantially improved the diagnostic detection of Fabry disease in females compared to the enzyme activity alone. Abnormal values for both were highly suspicious of Fabry disease (97% positive predictive value [PPV], similar to PPV in males). In cases with one abnormal biochemical value, elevated lyso-GL-3 is a far more important indicator than low enzyme activity (39% PPV vs 6% PPV). Cases with clearly negative results for both biochemical parameters are unlikely to have Fabry disease, even in clinically highly suspicious cases.
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Affiliation(s)
| | | | | | | | - Berthold Streubel
- Department of Pathology, The Medical University of Vienna, Vienna, Austria
| | - Paulina N Cobos
- Newborn Screening and Metabolic Diagnostics Unit, Hamburg University Medical Center, Hamburg, Germany
| | - Zoltan Lukacs
- Newborn Screening and Metabolic Diagnostics Unit, Hamburg University Medical Center, Hamburg, Germany
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21
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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22
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Landini S, Mazzinghi B, Becherucci F, Allinovi M, Provenzano A, Palazzo V, Ravaglia F, Artuso R, Bosi E, Stagi S, Sansavini G, Guzzi F, Cirillo L, Vaglio A, Murer L, Peruzzi L, Pasini A, Materassi M, Roperto RM, Anders HJ, Rotondi M, Giglio SR, Romagnani P. Reverse Phenotyping after Whole-Exome Sequencing in Steroid-Resistant Nephrotic Syndrome. Clin J Am Soc Nephrol 2019; 15:89-100. [PMID: 31831576 PMCID: PMC6946071 DOI: 10.2215/cjn.06060519] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 10/08/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Nephrotic syndrome is a typical presentation of genetic podocytopathies but occasionally other genetic nephropathies can present as clinically indistinguishable phenocopies. We hypothesized that extended genetic testing followed by reverse phenotyping would increase the diagnostic rate for these patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS All patients diagnosed with nephrotic syndrome and referred to our center between 2000 and 2018 were assessed in this retrospective study. When indicated, whole-exome sequencing and in silico filtering of 298 genes related to CKD were combined with subsequent reverse phenotyping in patients and families. Pathogenic variants were defined according to current guidelines of the American College of Medical Genetics. RESULTS A total of 111 patients (64 steroid-resistant and 47 steroid-sensitive) were included in the study. Not a single pathogenic variant was detected in the steroid-sensitive group. Overall, 30% (19 out of 64) of steroid-resistant patients had pathogenic variants in podocytopathy genes, whereas a substantial number of variants were identified in other genes, not commonly associated with isolated nephrotic syndrome. Reverse phenotyping, on the basis of a personalized diagnostic workflow, permitted to identify previously unrecognized clinical signs of an unexpected underlying genetic nephropathy in a further 28% (18 out of 64) of patients. These patients showed similar multidrug resistance, but different long-term outcome, when compared with genetic podocytopathies. CONCLUSIONS Reverse phenotyping increased the diagnostic accuracy in patients referred with the diagnosis of steroid-resistant nephrotic syndrome.
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Affiliation(s)
- Samuela Landini
- Medical Genetics Unit, Meyer Children's University Hospital, Florence, Italy.,Department of Clinical and Experimental Biomedical Sciences "Mario Serio,".,Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), and
| | - Benedetta Mazzinghi
- Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy
| | - Francesca Becherucci
- Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy
| | - Marco Allinovi
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio,".,Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), and
| | - Aldesia Provenzano
- Medical Genetics Unit, Meyer Children's University Hospital, Florence, Italy.,Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), and
| | - Viviana Palazzo
- Medical Genetics Unit, Meyer Children's University Hospital, Florence, Italy
| | - Fiammetta Ravaglia
- Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy
| | - Rosangela Artuso
- Medical Genetics Unit, Meyer Children's University Hospital, Florence, Italy
| | - Emanuele Bosi
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio,"
| | - Stefano Stagi
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Giulia Sansavini
- Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy
| | - Francesco Guzzi
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio,".,Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), and.,Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy
| | - Luigi Cirillo
- Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy
| | - Augusto Vaglio
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio,".,Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), and.,Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy
| | - Luisa Murer
- Pediatric Nephrology Dialysis and Transplant Unit, Department of Pediatrics, University of Padua, Padua, Italy
| | - Licia Peruzzi
- Pediatric Nephrology Unit, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Andrea Pasini
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Marco Materassi
- Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy
| | - Rosa Maria Roperto
- Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy
| | - Hans-Joachim Anders
- Medizinische Klinik and Poliklinik IV, Klinikum der Ludwig Maximilians University (LMU) München, München, Germany; and
| | - Mario Rotondi
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), University of Pavia, Pavia, Italy
| | - Sabrina Rita Giglio
- Medical Genetics Unit, Meyer Children's University Hospital, Florence, Italy.,Department of Clinical and Experimental Biomedical Sciences "Mario Serio,".,Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), and
| | - Paola Romagnani
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio," .,Excellence Centre for Research, Transfer and High Education for the development of DE NOVO Therapies (DENOTHE), and.,Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy
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23
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Godel T, Bäumer P, Stumpfe K, Muschol N, Kronlage M, Brunnée M, Kollmer J, Heiland S, Bendszus M, Mautner V. Dorsal root ganglia volume is increased in patients with the Fabry-related GLA variant p.D313Y. J Neurol 2019; 266:1332-9. [DOI: 10.1007/s00415-019-09262-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 02/24/2019] [Accepted: 02/26/2019] [Indexed: 10/27/2022]
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24
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Affiliation(s)
- D. Oder
- Department of Internal Medicine I; University Hospital Würzburg; Würzburg Germany
| | - C. Wanner
- Department of Internal Medicine I; University Hospital Würzburg; Würzburg Germany
| | - P. Nordbeck
- Department of Internal Medicine I; University Hospital Würzburg; Würzburg Germany
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