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Cianci V, Pascarella A, Manzo L, Gasparini S, Marsico O, Mammì A, Rao CM, Franzutti C, Aguglia U, Ferlazzo E. Late-onset fabry disease due to the p.Phe113Leu variant: the first italian cluster of five families. Metab Brain Dis 2023; 38:1905-1912. [PMID: 37097439 PMCID: PMC10348951 DOI: 10.1007/s11011-023-01216-4] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 04/15/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND The GLA c.337T > C (p.Phe113Leu) is a known pathogenic variant associated to late-onset Fabry disease phenotype with predominant cardiac manifestations. A founder effect was demonstrated in a large cohort in the Portuguese region of Guimarães. Herein we report an in-depth phenotype description of a cluster of five Southern Italy families. METHODS Family pedigrees of five index males with the p.Phe113Leu variant were obtained and all at-risk relatives underwent biochemical and genetical screening test. Carriers of GLA p.Phe113Leu variant underwent subsequent multidisciplinary clinical and instrumental evaluation. RESULTS Thirty-one (16 M, 15 F) individuals with p.Phe113Leu pathogenic variant were identified. Sixteen out of 31 patients (51.6%) had cardiac manifestations. Notably, myocardial fibrosis was found in 7/8 patients, of whom 2 were under 40 years. Stroke occurred in 4 patients. White matter lesions were detected in 12/19 patients and occurred in 2/10 of subjects under 40 years. Seven females complained of acroparesthesias. Renal involvement occurred in 10 patients. Angiokeratomas were evident in 9 subjects. Eyes, ear, gastrointestinal and pulmonary involvement occurred in the minority of subjects. CONCLUSION This study demonstrates that a cluster of subjects with p.Phe113Leu pathogenic variant is also present in Southern Italy. Disease manifestations are frequent in both sexes and may occur early in life. Cardiac involvement represents the core manifestation, but neurological and renal involvement is also frequent, suggesting that extra-cardiac complications deserve clinical attention.
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Affiliation(s)
- Vittoria Cianci
- Regional Epilepsy Centre, "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Angelo Pascarella
- Regional Epilepsy Centre, "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria, Italy
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Lucia Manzo
- Regional Epilepsy Centre, "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria, Italy
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Sara Gasparini
- Regional Epilepsy Centre, "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria, Italy
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Oreste Marsico
- Regional Epilepsy Centre, "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria, Italy
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Anna Mammì
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Carmelo Massimiliano Rao
- Cardiology Unit, "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Claudio Franzutti
- Radiology Unit, "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Umberto Aguglia
- Regional Epilepsy Centre, "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria, Italy.
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy.
| | - Edoardo Ferlazzo
- Regional Epilepsy Centre, "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria, Italy
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
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Müntze J, Lau K, Cybulla M, Brand E, Cairns T, Lorenz L, Üçeyler N, Sommer C, Wanner C, Nordbeck P. Patient reported quality of life and medication adherence in Fabry disease patients treated with migalastat: A prospective, multicenter study. Mol Genet Metab 2023; 138:106981. [PMID: 36709535 DOI: 10.1016/j.ymgme.2022.106981] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 10/25/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
AIMS Chaperone therapy with migalastat is a novel therapy option in Fabry disease (FD). In contrast to biweekly intravenous enzyme-replacement-therapy in a healthcare setting, oral delivery of migalastat every other day relies on the patient self-administration. Therapy adherence to migalastat and patient reported outcomes have not yet been studied in a real-world scenario. METHODS AND RESULTS Prospective multicenter 'MigALastat Therapy Adherence among FABRY patients' (MALTA-FABRY) study examined therapy adherence and patient-reported outcomes including quality of life in FD-patients receiving migalastat. Outcome measurements were elicited by the 'Medication Adherence Questionnaire (MAQ)', 'SF-36' and 'Fabry Pain Questionnaire' over a follow-up period of 24 months. Therapy adherence was graded as high (MAQ score of 4), medium (score of 2-3) or low (score 0-1). Within the recruitment period between 2017 and 2021, 40 patients (19 females) from 3 German FD-centers were included in the study. Nearly all patients (n = 37, 92.5%) showed good therapy adherence (MAQ6Mmean:3.93, MAQ12Mmean:3.71 and MAQ24Mmean:3.7). Only one patient fulfilled criteria for low adherence. Patient reported outcomes with completed SF-36 questionnaires were available in 28 patients (14 females). Over 24 months, significant improvement of pain and life role limitations due to physical activity was reported (Pain: change from baseline: 8.57 points, 95%-CI: 1.32-15.82, p = 0.022; role limitations physical: change from baseline: 13.39 points, 95%-CI: 0.61-23.2, p = 0.048). CONCLUSION Migalastat therapy adherence in FD-patients was high and remained high over a follow-up period of 2 years. Patient reported quality of life remained mostly stable, while pain and physical limitations improved over time.
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Affiliation(s)
- Jonas Müntze
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany; Fabry Center for Interdisciplinary Therapy (FAZiT), University Hospital Würzburg, Würzburg, Germany
| | - Kolja Lau
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany; Fabry Center for Interdisciplinary Therapy (FAZiT), University Hospital Würzburg, Würzburg, Germany
| | - Markus Cybulla
- Department of Nephrology and Rheumatology, FGM, Center of Internal Medicine, Müllheim, Germany
| | - Eva Brand
- Department of Internal Medicine D, and Interdisciplinary Fabry Center (IFAZ), University Hospital Münster, Münster, Germany
| | - Tereza Cairns
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany; Fabry Center for Interdisciplinary Therapy (FAZiT), University Hospital Würzburg, Würzburg, Germany
| | - Lora Lorenz
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany; Fabry Center for Interdisciplinary Therapy (FAZiT), University Hospital Würzburg, Würzburg, Germany
| | - Nurcan Üçeyler
- Fabry Center for Interdisciplinary Therapy (FAZiT), University Hospital Würzburg, Würzburg, Germany; Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Claudia Sommer
- Fabry Center for Interdisciplinary Therapy (FAZiT), University Hospital Würzburg, Würzburg, Germany; Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Christoph Wanner
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany; Fabry Center for Interdisciplinary Therapy (FAZiT), University Hospital Würzburg, Würzburg, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany; Fabry Center for Interdisciplinary Therapy (FAZiT), University Hospital Würzburg, Würzburg, Germany.
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Zemánek D, Januška J, Honěk T, Čurila K, Kubánek M, Šindelářová Š, Zahálková L, Klofáč P, Laštůvková E, Lichnerová E, Aiglová R, Lhotský J, Vondrák J, Dostálová G, Táborský M, Kasper D, Linhart A. Nationwide screening of Fabry disease in patients with hypertrophic cardiomyopathy in Czech Republic. ESC Heart Fail 2022; 9:4160-4166. [PMID: 36087038 PMCID: PMC9773751 DOI: 10.1002/ehf2.14135] [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: 03/11/2022] [Revised: 06/17/2022] [Accepted: 08/29/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS Fabry disease (FD) is a rare X-linked genetic disorder caused by α-galactosidase A (AGALA) deficiency. Whereas 'classic' variant has multisystemic manifestation, the more recently described 'later-onset' variant is characterized by predominant cardiac involvement that often mimics hypertrophic cardiomyopathy (HCM). METHODS AND RESULTS Consecutive unrelated patients with HCM were screened for FD in 16 (out of 17) cardiac centres in the Czech Republic covering specialized cardiology care from June 2017 to December 2018. AGALA activity and globotriaosylsphingosine (lyso-Gb3 ) levels were measured in all subjects using the dry blood spot method. FD was suspected in male patients with AGALA activity <1.2 μmol/h/L and in females with either low AGALA activity or lyso-Gb3 > 3.5 ng/mL. Positive screening results were confirmed by genetic testing. We evaluated 589 patients (390 males, 66%) with HCM (mean maximal myocardial thickness 19.1 ± 4.3 mm). The average age was 58.4 ± 14.7 years. In total, 17 patients (11 males, 6 females) had a positive screening result, and subsequently, six of them (four males and two females) had a genetically confirmed pathogenic GLA mutation (total prevalence of 1.02%). Five of these patients were carrying the p.N215S mutation known to cause a typical later-onset cardiac FD. CONCLUSIONS We confirmed the prevalence of FD repeatedly reported in previous screening programmes (approximately 1% irrespective of gender) in a non-selected HCM population in Central Europe. Our findings advocate a routine screening for FD in all adult patients with HCM phenotype including both genders. The dry blood spot method used led to identification of clearly pathogenic variants.
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Affiliation(s)
- David Zemánek
- 2nd Department of Internal Medicine Cardiology and AngiologyGeneral University Hospital and 1st Faculty of Medicine of Charles UniversityPragueCzech Republic
| | | | - Tomáš Honěk
- 1st Department of Internal Medicine ‐ CardioangiologySt Anne's University Hospital and Masaryk UniversityBrnoCzech Republic
| | - Karol Čurila
- Department of Cardiology, 3rd Faculty of MedicineCharles University and University Hospital Kralovské VinohradyPragueCzech Republic
| | - Miloš Kubánek
- Department of CardiologyInstitute for Clinical and Experimental MedicinePragueCzech Republic
| | | | - Lucie Zahálková
- 1st Department of Medicine ‐ CardioangiologyCharles University Faculty of Medicine and University HospitalHradec KrálovéCzech Republic
| | - Petr Klofáč
- Department of CardiologyRegional Hospital LiberecLiberecCzech Republic
| | | | - Eva Lichnerová
- Department of Cardiovascular DiseaseUniversity Hospital in OstravaOstravaCzech Republic
| | - Renata Aiglová
- Department of Internal Medicine I ‐ Cardiology, Faculty of Medicine and DentistryPalacký University and University Hospital OlomoucOlomoucCzech Republic
| | - Jan Lhotský
- Department of Cardiology, University Hospital and Faculty of Medicine PilsenCharles UniversityPragueCzech Republic
| | - Jiří Vondrák
- Department of Cardiology, Regional Hospital Pardubice and Faculty of Health StudiesUniversity of PardubicePardubiceCzech Republic
| | - Gabriela Dostálová
- 2nd Department of Internal Medicine Cardiology and AngiologyGeneral University Hospital and 1st Faculty of Medicine of Charles UniversityPragueCzech Republic
| | - Miloš Táborský
- Department of Internal Medicine I ‐ Cardiology, Faculty of Medicine and DentistryPalacký University and University Hospital OlomoucOlomoucCzech Republic
| | | | - Aleš Linhart
- 2nd Department of Internal Medicine Cardiology and AngiologyGeneral University Hospital and 1st Faculty of Medicine of Charles UniversityPragueCzech Republic
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Cybulla M, Nicholls K, Feriozzi S, Linhart A, Torras J, Vujkovac B, Botha J, Anagnostopoulou C, West ML. Renoprotective Effect of Agalsidase Alfa: A Long-Term Follow-Up of Patients with Fabry Disease. J Clin Med 2022; 11:jcm11164810. [PMID: 36013057 PMCID: PMC9410255 DOI: 10.3390/jcm11164810] [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: 06/30/2022] [Revised: 08/11/2022] [Accepted: 08/13/2022] [Indexed: 12/04/2022] Open
Abstract
Fabry disease is a rare lysosomal storage disorder caused by mutations in the GLA gene, which, without treatment, can cause significant renal dysfunction. We evaluated the effects of enzyme replacement therapy with agalsidase alfa on renal decline in patients with Fabry disease using data from the Fabry Outcome Survey (FOS) registry. Male patients with Fabry disease aged >16 years at agalsidase alfa start were stratified by low (≤0.5 g/24 h) or high (>0.5 g/24 h) baseline proteinuria and by ‘classic’ or ‘non-classic’ phenotype. Overall, 193 male patients with low (n = 135) or high (n = 58) baseline proteinuria were evaluated. Compared with patients with low baseline proteinuria, those with high baseline proteinuria had a lower mean ± standard deviation baseline eGFR (89.1 ± 26.2 vs. 106.6 ± 21.8 mL/min/1.73 m2) and faster mean ± standard error eGFR decline (−3.62 ± 0.42 vs. −1.61 ± 0.28 mL/min/1.73 m2 per year; p < 0.0001). Patients with classic Fabry disease had similar rates of eGFR decline irrespective of baseline proteinuria; only one patient with non-classic Fabry disease had high baseline proteinuria, preventing meaningful comparisons between groups. In this analysis, baseline proteinuria significantly impacted the rate of eGFR decline in the overall population, suggesting that early treatment with good proteinuria control may be associated with renoprotective effects.
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Affiliation(s)
- Markus Cybulla
- Center of Internal Medicine, Department of Nephrology and Rheumatology, Nephrologicum Markgräflerland MVZ, 79379 Müllheim, Germany
- Correspondence:
| | - Kathleen Nicholls
- Department of Nephrology, Royal Melbourne Hospital, Parkville, VIC 3050, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
| | - Sandro Feriozzi
- Nephrology and Dialysis Unit, Belcolle Hospital, 01100 Viterbo, Italy
| | - Aleš Linhart
- Second Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, 12808 Prague, Czech Republic
| | - Joan Torras
- Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Faculty of Medicine, Campus Bellvitge, University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Bojan Vujkovac
- Department of Internal Medicine, Slovenj Gradec General Hospital, 2380 Slovenj Gradec, Slovenia
| | - Jaco Botha
- Takeda Pharmaceuticals International AG, 8152 Zurich, Switzerland
| | | | - Michael L. West
- Department of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
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Tolstik E, Ali N, Guo S, Ebersbach P, Möllmann D, Arias-Loza P, Dierks J, Schuler I, Freier E, Debus J, Baba HA, Nordbeck P, Bocklitz T, Lorenz K. CARS Imaging Advances Early Diagnosis of Cardiac Manifestation of Fabry Disease. Int J Mol Sci 2022; 23:5345. [PMID: 35628155 DOI: 10.3390/ijms23105345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/05/2022] [Accepted: 05/08/2022] [Indexed: 12/12/2022] Open
Abstract
Vibrational spectroscopy can detect characteristic biomolecular signatures and thus has the potential to support diagnostics. Fabry disease (FD) is a lipid disorder disease that leads to accumulations of globotriaosylceramide in different organs, including the heart, which is particularly critical for the patient’s prognosis. Effective treatment options are available if initiated at early disease stages, but many patients are late- or under-diagnosed. Since Coherent anti-Stokes Raman (CARS) imaging has a high sensitivity for lipid/protein shifts, we applied CARS as a diagnostic tool to assess cardiac FD manifestation in an FD mouse model. CARS measurements combined with multivariate data analysis, including image preprocessing followed by image clustering and data-driven modeling, allowed for differentiation between FD and control groups. Indeed, CARS identified shifts of lipid/protein content between the two groups in cardiac tissue visually and by subsequent automated bioinformatic discrimination with a mean sensitivity of 90–96%. Of note, this genotype differentiation was successful at a very early time point during disease development when only kidneys are visibly affected by globotriaosylceramide depositions. Altogether, the sensitivity of CARS combined with multivariate analysis allows reliable diagnostic support of early FD organ manifestation and may thus improve diagnosis, prognosis, and possibly therapeutic monitoring of FD.
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Lau K, Üçeyler N, Cairns T, Lorenz L, Sommer C, Schindehütte M, Amann K, Wanner C, Nordbeck P. Gene variants of unknown significance in Fabry disease: Clinical characteristics of c.376A>G (p.Ser126Gly). Mol Genet Genomic Med 2022; 10:e1912. [PMID: 35212486 PMCID: PMC9034661 DOI: 10.1002/mgg3.1912] [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: 12/03/2021] [Revised: 02/03/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background Anderson–Fabry disease (FD) is an X‐linked lysosomal storage disorder with varying organ involvement and symptoms, depending on the underlying mutation in the alpha‐galactosidase A gene (HGNC: GLA). With genetic testing becoming more readily available, it is crucial to precisely evaluate pathogenicity of each genetic variant, in order to determine whether there is or might be not a need for FD‐specific therapy in affected patients and relatives at the time point of presentation or in the future. Methods This case series investigates the clinical impact of the specific GLA gene variant c.376A>G (p.Ser126Gly) in five (one heterozygous and one homozygous female, three males) individuals from different families, who visited our center between 2009 and 2021. Comprehensive neurological, nephrological and cardiac examinations were performed in all cases. One patient received a follow‐up examination after 12 years. Results Index events leading to suspicion of FD were mainly unspecific neurological symptoms. However, FD‐specific biomarkers, imaging examinations (i.e., brain MRI, heart MRI), and tissue‐specific diagnostics, including kidney and skin biopsies, did not reveal evidence for FD‐specific symptoms or organ involvement but showed normal results in all cases. This includes findings from 12‐year follow‐up in one patient with renal biopsy. Conclusion These findings suggest that p.Ser126Gly represents a benign GLA gene variant which per se does not cause FD. Precise clinical evaluation in individuals diagnosed with genetic variations of unknown significance should be performed to distinguish common symptoms broadly prevalent in the general population from those secondary to FD.
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Affiliation(s)
- Kolja Lau
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Fabry Center for Interdisciplinary Therapy (FAZiT), University Hospital Würzburg, Würzburg, Germany
| | - Nurcan Üçeyler
- Fabry Center for Interdisciplinary Therapy (FAZiT), University Hospital Würzburg, Würzburg, Germany.,Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Tereza Cairns
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Fabry Center for Interdisciplinary Therapy (FAZiT), University Hospital Würzburg, Würzburg, Germany
| | - Lora Lorenz
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Fabry Center for Interdisciplinary Therapy (FAZiT), University Hospital Würzburg, Würzburg, Germany
| | - Claudia Sommer
- Fabry Center for Interdisciplinary Therapy (FAZiT), University Hospital Würzburg, Würzburg, Germany.,Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Magnus Schindehütte
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Kerstin Amann
- Department of Nephropathology, Department of Pathology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Christoph Wanner
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Fabry Center for Interdisciplinary Therapy (FAZiT), University Hospital Würzburg, Würzburg, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Fabry Center for Interdisciplinary Therapy (FAZiT), University Hospital Würzburg, Würzburg, Germany
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Azevedo O, Cordeiro F, Gago MF, Miltenberger-Miltenyi G, Ferreira C, Sousa N, Cunha D. Fabry Disease and the Heart: A Comprehensive Review. Int J Mol Sci 2021; 22:4434. [PMID: 33922740 DOI: 10.3390/ijms22094434] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 12/17/2022] Open
Abstract
Fabry disease (FD) is an X-linked lysosomal storage disorder caused by mutations of the GLA gene that result in a deficiency of the enzymatic activity of α-galactosidase A and consequent accumulation of glycosphingolipids in body fluids and lysosomes of the cells throughout the body. GB3 accumulation occurs in virtually all cardiac cells (cardiomyocytes, conduction system cells, fibroblasts, and endothelial and smooth muscle vascular cells), ultimately leading to ventricular hypertrophy and fibrosis, heart failure, valve disease, angina, dysrhythmias, cardiac conduction abnormalities, and sudden death. Despite available therapies and supportive treatment, cardiac involvement carries a major prognostic impact, representing the main cause of death in FD. In the last years, knowledge has substantially evolved on the pathophysiological mechanisms leading to cardiac damage, the natural history of cardiac manifestations, the late-onset phenotypes with predominant cardiac involvement, the early markers of cardiac damage, the role of multimodality cardiac imaging on the diagnosis, management and follow-up of Fabry patients, and the cardiac efficacy of available therapies. Herein, we provide a comprehensive and integrated review on the cardiac involvement of FD, at the pathophysiological, anatomopathological, laboratory, imaging, and clinical levels, as well as on the diagnosis and management of cardiac manifestations, their supportive treatment, and the cardiac efficacy of specific therapies, such as enzyme replacement therapy and migalastat.
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Oder D, Müntze J, Nordbeck P. Contemporary therapeutics and new drug developments for treatment of Fabry disease: a narrative review. Cardiovasc Diagn Ther 2021; 11:683-695. [PMID: 33968645 DOI: 10.21037/cdt-20-743] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Fabry disease (OMIM 301500) is an X-linked (Xq22.1) lysosomal storage disorder leading to a progressive multisystem disease with high variability in both genotype and phenotype expression. The pathophysiological origin is found in an enzyme deficiency of the α-galactosidase A (enzyme commission no. 3.2.1.22) leading to accumulation of globotriaosylceramides in all lysosome carrying tissue. Especially organ manifestations of the heart, kidneys and nervous system are of significant prognostic value and might complicate with Fabry-associated pain, young aged cryptogenic stroke, proteinuria, kidney failure, hypertrophic cardiomyopathy, heart failure, malign cardiac rhythm disturbances and eventually sudden cardiac death. Up to the introduction of the first enzyme replacement agent in 2001, patients faced the disease's natural course with no disease-specific therapies available. Today, two recombinant enzyme replacement agents (Fabrazyme®, Sanofi Genzyme, Cambridge, MA, USA; Replagal®, Takeda Pharmaceutical, Tokio, Japan) and one oral chaperone therapy (Migalastat®, Amicus Therapeutics, USA) are available and well-established in daily clinical practice. Substrate reduction therapy, second-generation enzyme replacement agents and different gene therapy approaches are currently undergoing preclinical and clinical trial phases and aim to improve therapeutic success and long-term outcome of patients with Fabry disease. This narrative review summarizes the currently available therapeutic options and future perspectives in Fabry disease.
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Affiliation(s)
- Daniel Oder
- Department of Internal Medicine I, Fabry Center for Interdisciplinary Therapy (FAZIT) and Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Würzburg, Germany
| | - Jonas Müntze
- Department of Internal Medicine I, Fabry Center for Interdisciplinary Therapy (FAZIT) and Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Würzburg, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, Fabry Center for Interdisciplinary Therapy (FAZIT) and Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Würzburg, Germany
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Caputo F, Lungaro L, Galdi A, Zoli E, Giancola F, Caio G, De Giorgio R, Zoli G. Gastrointestinal Involvement in Anderson-Fabry Disease: A Narrative Review. Int J Environ Res Public Health 2021; 18:3320. [PMID: 33807115 DOI: 10.3390/ijerph18063320] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 12/31/2022]
Abstract
Anderson-Fabry disease (FD) is an X-linked lysosomal storage disorder leading to a wide array of clinical manifestations. Among these, gastrointestinal (GI) symptoms such as abdominal pain, bloating, and diarrhea affect about half of the FD adults and more than half of FD children. GI symptoms could be the first manifestation of FD; however, being non-specific, they overlap with the clinical picture of other conditions, such as irritable bowel syndrome and inflammatory bowel disease. This common overlap is the main reason why FD patients are often unrecognized and diagnosis is delayed for many years. The present narrative review is aimed to promote awareness of the GI manifestations of FD amongst general practitioners and specialists and highlight the latest findings of this rare condition including diagnostic tools and therapies. Finally, we will discuss some preliminary data on a patient presenting with GI symptoms who turned to be affected by a variant of uncertain significance of alpha-galactosidase (GLA) gene.
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Hopkin RJ, Feldt-Rasmussen U, Germain DP, Jovanovic A, Martins AM, Nicholls K, Ortiz A, Politei J, Ponce E, Varas C, Weidemann F, Yang M, Wilcox WR. Improvement of gastrointestinal symptoms in a significant proportion of male patients with classic Fabry disease treated with agalsidase beta: A Fabry Registry analysis stratified by phenotype. Mol Genet Metab Rep 2020; 25:100670. [PMID: 33163363 PMCID: PMC7606866 DOI: 10.1016/j.ymgmr.2020.100670] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 08/07/2020] [Revised: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 12/22/2022] Open
Abstract
Background Fabry disease is an inherited disorder of glycolipid metabolism with progressive involvement of multiple organs, including the gastrointestinal tract, in classically affected male patients. Clinical presentations in males with later-onset Fabry phenotypes are more heterogeneous and largely dependent on the level of residual α-galactosidase A activity. Methods We assessed agalsidase beta treatment outcomes of gastrointestinal symptoms in adult males with classic or later-onset Fabry disease. Self-reports of abdominal pain and diarrhea ('present'/'not present' since previous assessment) at last clinical visit (≥0.5 year of follow-up) were compared with treatment-baseline. Results Classic male patients were considerably younger at first treatment than the fewer males with later-onset phenotypes (36 vs. ~47 years) and reported gastrointestinal symptoms more frequently at baseline (abdominal pain: 56% vs. 13%; diarrhea: 57% vs. 23%). As compared with baseline, significantly fewer classic patients reported abdominal pain after a median of 4.7 years of treatment (N = 171, 56% vs. 41%, P < 0.001). Moreover, significantly fewer patients reported diarrhea after 5.5 years of follow-up (N = 169, 57% vs. 47%, P < 0.05). Among the males with later-onset phenotypes, albeit statistically non-significant, abdominal pain reports reduced after a median of 4.2 years (N = 48, 13% vs. 4%) and diarrhea reports reduced after a median of 4.4 years of treatment (N = 47, 23% vs. 13%). Conclusions Sustained treatment with agalsidase beta was associated with improvement in abdominal pain and diarrhea in a significant proportion of classic male Fabry patients. Males with later-onset phenotypes reported gastrointestinal symptoms much less frequently at baseline as compared with classic patients, and non-significant reductions were observed.
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Affiliation(s)
- Robert J. Hopkin
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Corresponding author at: Division of Human Genetics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., ML 4006, Cincinnati, OH 45229-3039, USA.
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Dominique P. Germain
- French Referral Centre for Fabry disease, Division of Medical Genetics, Paris Saclay University, Garches, France
| | - Ana Jovanovic
- The Mark Holland Unit, Department of Endocrinology and Metabolic Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Ana Maria Martins
- Reference Center for Inborn Errors of Metabolism, Federal University of São Paulo, São Paulo, Brazil
| | - Kathleen Nicholls
- Department of Nephrology, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Alberto Ortiz
- Unidad de Dialisis, IIS-Fundación Jiménez Díaz, UAM, IRSIN and REDINREN, Madrid, Spain
| | - Juan Politei
- Neurology Department, Fundación para el Estudio de las Enfermedades Neurometabólicas (FESEN), Buenos Aires, Argentina
| | - Elvira Ponce
- Global Medical Affairs Rare Diseases, Sanofi Genzyme, Cambridge, MA, USA
| | - Carmen Varas
- Fabry Disease Multidisciplinary Team, Hospital San Pablo de Coquimbo, Coquimbo, Chile
| | - Frank Weidemann
- Medical Clinic I, Klinikum Vest, Knappschaftskrankenhaus, Recklinghausen, Germany
| | - Meng Yang
- Epidemiology & Biostatistics, Sanofi Genzyme, Cambridge, MA, USA
| | - William R. Wilcox
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
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11
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Linhart A, Germain DP, Olivotto I, Akhtar MM, Anastasakis A, Hughes D, Namdar M, Pieroni M, Hagège A, Cecchi F, Gimeno JR, Limongelli G, Elliott P. An expert consensus document on the management of cardiovascular manifestations of Fabry disease. Eur J Heart Fail 2020; 22:1076-1096. [PMID: 32640076 DOI: 10.1002/ejhf.1960] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [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: 05/17/2020] [Revised: 07/04/2020] [Accepted: 07/04/2020] [Indexed: 12/18/2022] Open
Abstract
Fabry disease (FD) is an X-linked lysosomal storage disorder caused by pathogenic variants in the α-galactosidase A (GLA) gene that leads to reduced or undetectable α-galactosidase A enzyme activity and progressive accumulation of globotriaosylceramide and its deacylated form globotriaosylsphingosine in cells throughout the body. FD can be multisystemic with neurological, renal, cutaneous and cardiac involvement or be limited to the heart. Cardiac involvement is characterized by progressive cardiac hypertrophy, fibrosis, arrhythmias, heart failure and sudden cardiac death. The cardiac management of FD requires specific measures including enzyme replacement therapy or small pharmacological chaperones in patients carrying amenable pathogenic GLA gene variants and more general management of cardiac symptoms and complications. In this paper, we summarize current knowledge of FD-related heart disease and expert consensus recommendations for its management.
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Affiliation(s)
- Aleš Linhart
- Second Department of Internal Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Dominique P Germain
- Division of Medical Genetics, University of Versailles and AP-HP Paris-Saclay, Paris, France
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Mohammed M Akhtar
- Institute of Cardiovascular Science, University College London and Barts Heart Centre, London, UK
| | - Aris Anastasakis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Center, Kallithea, Greece
| | - Derralynn Hughes
- Royal Free London NHS Foundation Trust and University College London, London, UK
| | - Mehdi Namdar
- Department of Internal Medicine Specialties, Cardiology, Electrophysiology, University Hospital of Geneva, Geneva, Switzerland
| | - Maurizio Pieroni
- Cardiomyopathy Clinic, Cardiovascular Department, San Donato Hospital, Arezzo, Italy
| | - Albert Hagège
- Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,INSERM CMR970, Paris Cardiovascular Research Center PARCC, Paris, France
| | - Franco Cecchi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy.,IRCCS, Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Juan R Gimeno
- Hospital C. Universitario Virgen Arrixaca, Murcia, Spain
| | - Giuseppe Limongelli
- Dipartimento di Scienze Mediche Traslazionali, Università della Campania "Luigi Vanvitelli", AORN Colli, Ospedale Monaldi, Naples, Italy
| | - Perry Elliott
- Institute of Cardiovascular Science, University College London and Barts Heart Centre, London, UK
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12
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Di Toro A, Narula N, Giuliani L, Concardi M, Smirnova A, Favalli V, Urtis M, Alvisi C, Antoniazzi E, Arbustini E. Pathologic substrate of gastropathy in Anderson-Fabry disease. Orphanet J Rare Dis 2020; 15:156. [PMID: 32571412 PMCID: PMC7310490 DOI: 10.1186/s13023-020-01436-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [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: 03/13/2020] [Accepted: 06/09/2020] [Indexed: 11/10/2022] Open
Abstract
In both classic and late-onset AFD, mutations of the GLA gene cause deficient activity of the alpha-galactosidase enzyme resulting in intracellular accumulation of the undigested substrate. Gastrointestinal symptoms (GI) are common but non-specific and imputed to the AFD, irrespective of the demonstration of substrate accumulation in GI cells. We demonstrate substrate accumulation in gastric epithelial, vascular, and nerve cells of patients with classic AFD and, vice versa, absence of accumulation in late-onset AFD and controls.
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Affiliation(s)
- Alessandro Di Toro
- Center for Inherited Cardiovascular Diseases, Transplant Research Area, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy
| | - Nupoor Narula
- Center for Inherited Cardiovascular Diseases, Transplant Research Area, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy.,Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Lorenzo Giuliani
- Center for Inherited Cardiovascular Diseases, Transplant Research Area, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy
| | - Monica Concardi
- Center for Inherited Cardiovascular Diseases, Transplant Research Area, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy
| | - Alexandra Smirnova
- Center for Inherited Cardiovascular Diseases, Transplant Research Area, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy
| | - Valentina Favalli
- Center for Inherited Cardiovascular Diseases, Transplant Research Area, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy.,European Institute of Oncology, Department of Experimental Oncology, Milan, Italy
| | - Mario Urtis
- Center for Inherited Cardiovascular Diseases, Transplant Research Area, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy
| | - Costanza Alvisi
- Internal Medicine - Endoscopy Unit, Ospedale Civile di Voghera, Voghera, ASST, Pavia, Italy
| | - Elena Antoniazzi
- Ophthalmology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Eloisa Arbustini
- Center for Inherited Cardiovascular Diseases, Transplant Research Area, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy.
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13
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Sheng B, Yim KF, Lau LK, Lee HCH, Fung KSS, Ma KFJ, Chak WL. Two related Chinese Fabry disease patients with a p.N215S pathological variant who presented with nephropathy. Mol Genet Metab Rep 2020; 24:100596. [PMID: 32435590 DOI: 10.1016/j.ymgmr.2020.100596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/24/2022] Open
Abstract
Fabry disease is an X-linked lysosomal storage disease resulting from a mutation in the GLA gene that encodes α-galactosidase A. The p.N215S (c.644A > G [p.Asn215Ser]) genotype is the most common later-onset variant reported in individuals of European or North American descent. It is usually referred to as a cardiac variant, although manifestations in other organ systems have been observed. In this report, we describe a nephropathy presentation in two related Chinese Fabry disease patients with p.N215S.
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14
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Lenders M, Nordbeck P, Kurschat C, Karabul N, Kaufeld J, Hennermann JB, Patten M, Cybulla M, Müntze J, Üçeyler N, Liu D, Das AM, Sommer C, Pogoda C, Reiermann S, Duning T, Gaedeke J, Stumpfe K, Blaschke D, Brand SM, Mann WA, Kampmann C, Muschol N, Canaan-Kühl S, Brand E. Treatment of Fabry's Disease With Migalastat: Outcome From a Prospective Observational Multicenter Study (FAMOUS). Clin Pharmacol Ther 2020; 108:326-337. [PMID: 32198894 DOI: 10.1002/cpt.1832] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/11/2020] [Indexed: 01/15/2023]
Abstract
Fabry's disease (FD) is an X-linked lysosomal storage disorder caused by the deficient activity of the lysosomal enzyme α-galactosidase A (α-Gal A) leading to intracellular accumulation of globotriaosylceramide (Gb3). Patients with amenable mutations can be treated with migalastat, a recently approved oral pharmacologic chaperone to increase endogenous α-Gal A activity. We assessed safety along with cardiovascular, renal, and patient-reported outcomes and disease biomarkers in a prospective observational multicenter study after 12 months of migalastat treatment under "real-world" conditions. Fifty-nine (28 females) patients (34 (57.6%) pretreated with enzyme replacement therapy) with amenable mutations were recruited. Migalastat was generally safe and well tolerated. Females and males presented with a reduction of left ventricular mass index (primary end point) (-7.2 and -13.7 g/m2 , P = 0.0050 and P = 0.0061). FD-specific manifestations and symptoms remained stable (all P > 0.05). Both sexes presented with a reduction of estimated glomerular filtration rate (secondary end point) (-6.9 and -5.0 mL/minute/1.73 m2 ; P = 0.0020 and P = 0.0004, respectively), which was most prominent in patients with low blood pressure (P = 0.0271). α-Gal A activity increased in male patients by 15% from 29% to 44% of the normal wild-type activity (P = 0.0106) and plasma lyso-Gb3 levels were stable in females and males (P = 0.3490 and P = 0.2009). Reevaluation of mutations with poor biochemical response revealed no marked activity increase in a zero activity background. We conclude that therapy with migalastat was generally safe and resulted in an amelioration of left ventricular mass. In terms of impaired renal function, blood pressure control seems to be an unattended important goal.
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Affiliation(s)
- Malte Lenders
- Department of Internal Medicine D, and Interdisciplinary Fabry Center (IFAZ), University Hospital Münster, Münster, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, Comprehensive Heart Failure Center, and Fabry Center for Interdisciplinary Therapy (FAZIT), University of Würzburg, Würzburg, Germany
| | - Christine Kurschat
- Department II of Internal Medicine, Center for Molecular Medicine Cologne and Center for Rare Diseases, University of Cologne, Cologne, Germany
| | - Nesrin Karabul
- Endokrinologikum Frankfurt, Center of Hormonal and Metabolic Diseases, Rheumatology, Osteology and Neurology, Frankfurt, Germany
| | - Jessica Kaufeld
- Department of Nephrology and Hypertension, Hannover Medical School, Germany
| | - Julia B Hennermann
- Villa Metabolica, Department for Pediatric and Adolescent Medicine, University Medical Center Mainz, Mainz, Germany
| | - Monica Patten
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Markus Cybulla
- Department of Nephrology and Rheumatology, FGM, Center of Internal Medicine, Müllheim, Germany
| | - Jonas Müntze
- Department of Internal Medicine I, Comprehensive Heart Failure Center, and Fabry Center for Interdisciplinary Therapy (FAZIT), University of Würzburg, Würzburg, Germany
| | - Nurcan Üçeyler
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Dan Liu
- Department of Internal Medicine I, Comprehensive Heart Failure Center, and Fabry Center for Interdisciplinary Therapy (FAZIT), University of Würzburg, Würzburg, Germany
| | - Anibh M Das
- Department of Paediatrics, Hannover Medical School, Hannover, Germany
| | - Claudia Sommer
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Christian Pogoda
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, and Interdisciplinary Fabry Center (IFAZ), University Hospital Münster, Münster, Germany
| | - Stefanie Reiermann
- Department of Internal Medicine D, and Interdisciplinary Fabry Center (IFAZ), University Hospital Münster, Münster, Germany
| | - Thomas Duning
- Department of Neurology, and Interdisciplinary Fabry Center (IFAZ), University Hospital Münster, Münster, Germany
| | - Jens Gaedeke
- Department of Medicine, Division of Nephrology, Charité, Campus Virchow-Klinikum, Berlin, Germany
| | - Katharina Stumpfe
- Department of Pediatrics, University Medical Center Hamburg, Eppendorf, Hamburg, Germany
| | - Daniela Blaschke
- Department of Medicine, Division of Cardiology, Charité, Campus Virchow-Klinikum, Berlin, Germany
| | - Stefan-Martin Brand
- Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease, and Interdisciplinary Fabry Center (IFAZ), University Hospital Münster, Münster, Germany
| | - W Alexander Mann
- Endokrinologikum Frankfurt, Center of Hormonal and Metabolic Diseases, Rheumatology, Osteology and Neurology, Frankfurt, Germany
| | - Christoph Kampmann
- Villa Metabolica, Department for Pediatric and Adolescent Medicine, University Medical Center Mainz, Mainz, Germany
| | - Nicole Muschol
- Department of Pediatrics, University Medical Center Hamburg, Eppendorf, Hamburg, Germany
| | - Sima Canaan-Kühl
- Department of Medicine, Division of Nephrology, Charité, Campus Virchow-Klinikum, Berlin, Germany
| | - Eva Brand
- Department of Internal Medicine D, and Interdisciplinary Fabry Center (IFAZ), University Hospital Münster, Münster, Germany
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15
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Hoss S, Habib M, Silver J, Care M, Chan RH, Hanneman K, Morel CF, Iwanochko RM, Gollob MH, Rakowski H, Adler A. Genetic Testing for Diagnosis of Hypertrophic Cardiomyopathy Mimics. Circ: Genomic and Precision Medicine 2020; 13:e002748. [DOI: 10.1161/circgen.119.002748] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background
Genetic testing is helpful for diagnosis of hypertrophic cardiomyopathy (HCM) mimics. Little data are available regarding the yield of such testing and its clinical impact.
Methods
The HCM genetic database at our center was used for identification of patients who underwent HCM-directed genetic testing including at least 1 gene associated with an HCM mimic (
GLA
,
TTR
,
PRKAG2
,
LAMP2
,
PTPN11
,
RAF1
, and
DES
). Charts were retrospectively reviewed and genetic and clinical data extracted.
Results
There were 1731 unrelated HCM patients who underwent genetic testing for at least 1 gene related to an HCM mimic. In 1.45% of cases, a pathogenic or likely pathogenic variant in one of these genes was identified. This included a yield of 1% for Fabry disease, 0.3% for familial amyloidosis, 0.15% for
PRKAG2
-related cardiomyopathy, and 1 patient with Noonan syndrome. In the majority of patients, diagnosis of the HCM mimic based on clinical findings alone would have been challenging. Accurate diagnosis of an HCM mimic led to change in management (eg, enzyme replacement therapy) or family screening in all cases.
Conclusions
Genetic testing is helpful in the diagnosis of HCM mimics in patients with no or few extracardiac manifestations. Adding these genes to all HCM genetic panels should be considered.
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Affiliation(s)
- Sara Hoss
- Division of Cardiology, Peter Munk Cardiac Centre (S.H., M.H., R.H.C., M.H.G., H.R., A.A.), Toronto General Hospital, Canada
- University of Toronto (S.H., M.H., J.S., M.C., K.H., C.F.M., R.M.I., M.H.G., H.R., A.A.)
| | - Manhal Habib
- Division of Cardiology, Peter Munk Cardiac Centre (S.H., M.H., R.H.C., M.H.G., H.R., A.A.), Toronto General Hospital, Canada
- University of Toronto (S.H., M.H., J.S., M.C., K.H., C.F.M., R.M.I., M.H.G., H.R., A.A.)
| | - Josh Silver
- Fred A. Litwin and Family Center in Genetic Medicine, University Health Network and Mount Sinai Hospital (J.S., M.C., C.F.M.), Toronto General Hospital, Canada
- University of Toronto (S.H., M.H., J.S., M.C., K.H., C.F.M., R.M.I., M.H.G., H.R., A.A.)
| | - Melanie Care
- Fred A. Litwin and Family Center in Genetic Medicine, University Health Network and Mount Sinai Hospital (J.S., M.C., C.F.M.), Toronto General Hospital, Canada
- University of Toronto (S.H., M.H., J.S., M.C., K.H., C.F.M., R.M.I., M.H.G., H.R., A.A.)
| | - Raymond H. Chan
- Division of Cardiology, Peter Munk Cardiac Centre (S.H., M.H., R.H.C., M.H.G., H.R., A.A.), Toronto General Hospital, Canada
| | - Kate Hanneman
- Joint Department of Medical Imaging (K.H.), Toronto General Hospital, Canada
- University of Toronto (S.H., M.H., J.S., M.C., K.H., C.F.M., R.M.I., M.H.G., H.R., A.A.)
| | - Chantal F. Morel
- Fred A. Litwin and Family Center in Genetic Medicine, University Health Network and Mount Sinai Hospital (J.S., M.C., C.F.M.), Toronto General Hospital, Canada
- University of Toronto (S.H., M.H., J.S., M.C., K.H., C.F.M., R.M.I., M.H.G., H.R., A.A.)
| | - Robert M. Iwanochko
- University of Toronto (S.H., M.H., J.S., M.C., K.H., C.F.M., R.M.I., M.H.G., H.R., A.A.)
- Division of Cardiology, Toronto Western Hospital, ON, Canada (R.M.I.)
| | - Michael H. Gollob
- Division of Cardiology, Peter Munk Cardiac Centre (S.H., M.H., R.H.C., M.H.G., H.R., A.A.), Toronto General Hospital, Canada
- University of Toronto (S.H., M.H., J.S., M.C., K.H., C.F.M., R.M.I., M.H.G., H.R., A.A.)
| | - Harry Rakowski
- Division of Cardiology, Peter Munk Cardiac Centre (S.H., M.H., R.H.C., M.H.G., H.R., A.A.), Toronto General Hospital, Canada
- University of Toronto (S.H., M.H., J.S., M.C., K.H., C.F.M., R.M.I., M.H.G., H.R., A.A.)
| | - Arnon Adler
- Division of Cardiology, Peter Munk Cardiac Centre (S.H., M.H., R.H.C., M.H.G., H.R., A.A.), Toronto General Hospital, Canada
- University of Toronto (S.H., M.H., J.S., M.C., K.H., C.F.M., R.M.I., M.H.G., H.R., A.A.)
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16
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Azevedo O, Gago MF, Miltenberger-Miltenyi G, Robles AR, Costa MA, Pereira O, Vide AT, Castelo Branco G, Simões S, Guimarães MJ, Salgado A, Sousa N, Cunha D. Natural history of the late-onset phenotype of Fabry disease due to the p.F113L mutation. Mol Genet Metab Rep 2020; 22:100565. [PMID: 32099817 PMCID: PMC7026617 DOI: 10.1016/j.ymgmr.2020.100565] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [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: 11/15/2019] [Revised: 01/05/2020] [Accepted: 01/06/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The common GLA gene mutation p.F113L causes late-onset phenotype of Fabry disease (FD) with predominant cardiac manifestations. A founder effect of FD due to this mutation was found in the Portuguese region of Guimarães. Our study aims to deepen the knowledge on the natural history of this late-onset variant. METHODS 203 consecutive adult Fabry patients with p.F113L mutation (79 males; mean age 46 ± 18 years), from this region, were submitted at baseline to a predefined diagnostic protocol. The occurrence of FD manifestations was analyzed in each decade of age in both genders. RESULTS In males, left ventricular hypertrophy (40.2%) and late gadolinium enhancement (21.4%) arose over 30 years; heart failure (HF) (21.9%), ventricular tachycardia (8.9%) and conduction disorders over 40 years; and bifascicular (13.1%) and complete atrioventricular blocks (5.9%) beyond 50 years of age. Cardiac manifestations occurred more commonly and 1-2 decades earlier in males; their frequency increased with age. Septum and posterior wall thickness, LV mass, QRS interval duration and pro-BNP levels increased with age in both genders. Mean survival free from HF (64 ± 1 vs. 76 ± 2 years) and pacemaker (71 ± 2 vs. 86 ± 1 years) was higher in females (p < .001). Albuminuria A2/A3 (33.7%), brain white matter lesions (50.3%) and sensorineural deafness (44.7%) arose before 30 years of age in both genders, increasing with age. Renal failure and stroke were rare. Lysosomal inclusions were demonstrated in podocytes of patients with proteinuria. CONCLUSION This study improves the knowledge on natural history of late-onset variants of FD, carrying major impact on clinical decisions and guidelines.
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Affiliation(s)
- Olga Azevedo
- Cardiology Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal, member of the European Reference Network on Hereditary Metabolic Disorders (MetabERN)
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Miguel F. Gago
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Neurology Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal, member of the European Reference Network on Hereditary Metabolic Disorders (MetabERN)
| | - Gabriel Miltenberger-Miltenyi
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Genetics Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal, member of the European Reference Network on Hereditary Metabolic Disorders (MetabERN)
| | - Ana Raquel Robles
- Otorhinolaryngology Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal, member of the European Reference Network on Hereditary Metabolic Disorders (MetabERN)
| | - Maria Antónia Costa
- Ophthalmology Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal, member of the European Reference Network on Hereditary Metabolic Disorders (MetabERN)
| | - Olga Pereira
- Dermatology Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal, member of the European Reference Network on Hereditary Metabolic Disorders (MetabERN)
| | - Ana Teresa Vide
- Neurorradiology Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal, member of the European Reference Network on Hereditary Metabolic Disorders (MetabERN)
| | - Gonçalo Castelo Branco
- Internal Medicine Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal, member of the European Reference Network on Hereditary Metabolic Disorders (MetabERN)
| | - Sónia Simões
- Psychiatry Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal, member of the European Reference Network on Hereditary Metabolic Disorders (MetabERN)
| | - Maria José Guimarães
- Pneumology Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal, member of the European Reference Network on Hereditary Metabolic Disorders (MetabERN)
| | - Ana Salgado
- Radiology Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal, member of the European Reference Network on Hereditary Metabolic Disorders (MetabERN)
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Damião Cunha
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal
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17
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Pietilä-Effati P, Saarinen JT, Löyttyniemi E, Autio R, Saarenhovi M, Haanpää MK, Kantola I. Natural course of Fabry disease with the p. Arg227Ter (p.R227*) mutation in Finland: Fast study. Mol Genet Genomic Med 2019; 7:e00930. [PMID: 31411008 PMCID: PMC6785458 DOI: 10.1002/mgg3.930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 04/09/2019] [Revised: 07/06/2019] [Accepted: 07/23/2019] [Indexed: 12/02/2022] Open
Abstract
Background Fabry disease is caused by a deficient or an absent alfa‐galactosidase A activity and is an X‐linked disorder that results in organ damage and a shortened life span, especially in males. The severity of the disease depends on the type of mutation, gender, skewed X‐chromosome inactivation, and other still unknown factors. Methods In this article, we describe the natural course of a common classic Fabry disease mutation, p.Arg227Ter or p.R227*, in Finland. Results Four males and ten females belonged to two extended families. The mean age was 46 years (SD 18.4). Six patients (43%) had cardiac hypertrophy, three patients (21%) had ischemic stroke, and none had severe kidney dysfunction. Three patients had atrial fibrillation; two patients who had atrial fibrillation also had pacemakers. All males over 30 years of age had at least one of the following manifestations: cardiac hypertrophy, stroke, or proteinuria. In females, the severity of Fabry disease varied from classic multiorgan disease to a condition that mimicked the attenuated cardiac variant. No one was totally asymptomatic without any signs of Fabry disease. Cardiac magnetic resonance imaging was performed on nine of 14 patients was the most sensitive for detecting early cardiac manifestations. Five patients (55%) had late gadolinium enhancement‐positive segments. Conclusion Cardiac involvement should be effectively detected in females before considering them asymptomatic mutation carriers.
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Affiliation(s)
| | | | | | - Reijo Autio
- Department of Radiology, Vaasa Central Hospital, Vaasa, Finland
| | - Maria Saarenhovi
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Maria K Haanpää
- Department of Clinical Genetics, Turku University Hospital, Turku, Finland
| | - Ilkka Kantola
- Division of Medicine, Turku University Hospital, University of Turku, Turku, Finland
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18
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Lamari F, Mauhin W, Koraichi F, Khrouf W, Bordet C, London J, Lidove O, Charron P. Strong increase of leukocyte apha-galactosidase A activity in two male patients with Fabry disease following oral chaperone therapy. Mol Genet Genomic Med 2019; 7:e894. [PMID: 31393666 PMCID: PMC6732277 DOI: 10.1002/mgg3.894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/20/2019] [Revised: 07/10/2019] [Accepted: 07/15/2019] [Indexed: 01/04/2023] Open
Abstract
Background Fabry disease (OMIM 301500) is an X‐linked disorder caused by alpha‐galactosidase A (α‐Gal A) deficiency. The administration of a pharmacologic chaperone (migalastat) in Fabry patients with amenable mutations has been reported to improve or stabilize organ damages and reduce lyso‐Gb3 plasma level. An increase of α‐Gal A activity has been observed in vitro in cells expressing amenable GLA mutations when incubated with migalastat. The impact of the drug on α‐Gal A in vivo activity has been poorly studied. Methods We conducted a retrospective analysis of two unrelated male Fabry patients with p.Asn215Ser (p.N215S) variant. Results We report the important increase of α‐Gal A activity in blood leukocytes reaching normal ranges of activity after about 1 year of treatment with migalastat. Cardiac parameters improved or stabilized with the treatment. Conclusion We confirm in vivo the effects of migalastat that have been observed in N215S carriers in vitro. The increase of α‐Gal A activity may be the strongest marker for biochemical efficacy. The normalization of enzyme activity could become the new therapeutic target to achieve.
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Affiliation(s)
- Foudil Lamari
- Laboratoire de Biochimie Métabolique, APHP, Hôpitaux Universitaires Pitié-Salpêtrière, Paris, France.,GRC 2011-Neurométabolisme, Université Pierre et Marie-Curie-Sorbonne, Paris, France
| | - Wladimir Mauhin
- Service de Médecine Interne, Centre de Référence des Maladies Lysosomales, Groupe Hospitalier Diaconesses-Croix St Simon, Paris, France
| | - Fairouz Koraichi
- Centre de Référence pour les Maladies Cardiaques Héréditaires, Département de Génétique, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Walid Khrouf
- Laboratoire de Biochimie Métabolique, APHP, Hôpitaux Universitaires Pitié-Salpêtrière, Paris, France
| | - Celine Bordet
- Centre de Référence pour les Maladies Cardiaques Héréditaires, Département de Génétique, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jonathan London
- Service de Médecine Interne, Centre de Référence des Maladies Lysosomales, Groupe Hospitalier Diaconesses-Croix St Simon, Paris, France
| | - Olivier Lidove
- Service de Médecine Interne, Centre de Référence des Maladies Lysosomales, Groupe Hospitalier Diaconesses-Croix St Simon, Paris, France
| | - Philippe Charron
- Centre de Référence pour les Maladies Cardiaques Héréditaires, Département de Génétique, APHP, Hôpital Pitié-Salpêtrière, Paris, France.,INSERM, UMR_S 1166 and ICAN Institute for Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
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19
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Reuter C, Platt J. Clinical Characteristics of the GLA N215S Variant and Implications for the Diagnosis and Management of Nonclassic Fabry Disease. ACTA ACUST UNITED AC 2019; 10:CIRCGENETICS.117.001918. [PMID: 29018007 DOI: 10.1161/circgenetics.117.001918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Chloe Reuter
- From the Department of Cardiology, Stanford Center for Inherited Cardiovascular Disease, Stanford Health Care, CA (C.R., J.P.); Stanford Center for Undiagnosed Diseases, CA (C.R.); and Department of Pediatrics, Division of Medical Genetics, Stanford University School of Medicine, CA (J.P.)
| | - Julia Platt
- From the Department of Cardiology, Stanford Center for Inherited Cardiovascular Disease, Stanford Health Care, CA (C.R., J.P.); Stanford Center for Undiagnosed Diseases, CA (C.R.); and Department of Pediatrics, Division of Medical Genetics, Stanford University School of Medicine, CA (J.P.).
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20
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Ramaswami U, Bichet DG, Clarke LA, Dostalova G, Fainboim A, Fellgiebel A, Forcelini CM, An Haack K, Hopkin RJ, Mauer M, Najafian B, Scott CR, Shankar SP, Thurberg BL, Tøndel C, Tylki-Szymanska A, Bénichou B, Wijburg FA. Low-dose agalsidase beta treatment in male pediatric patients with Fabry disease: A 5-year randomized controlled trial. Mol Genet Metab 2019; 127:86-94. [PMID: 30987917 DOI: 10.1016/j.ymgme.2019.03.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 12/13/2018] [Revised: 03/06/2019] [Accepted: 03/30/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Fabry disease is a rare, X-linked, lifelong progressive lysosomal storage disorder. Severely deficient α-galactosidase A activity in males is associated with the classic phenotype with early-onset, multisystem manifestations evolving to vital organ complications during adulthood. We assessed the ability of 2 low-dose agalsidase beta regimens to lower skin, plasma, and urine globotriaosylceramide (GL-3) levels, and influence clinical manifestations in male pediatric Fabry patients. METHODS In this multicenter, open-label, parallel-group, phase 3b study, male patients aged 5-18 years were randomized to receive agalsidase beta at 0.5 mg/kg 2-weekly (n = 16) or 1.0 mg/kg 4-weekly (n = 15) for 5 years. All had plasma/urine GL-3 accumulation but no clinically evident organ involvement. The primary outcome was GL-3 accumulation in superficial skin capillary endothelium (SSCE). RESULTS The mean age was 11.6 (range: 5-18) years and all but one of the 31 patients had classic GLA mutations. In the overall cohort, shifts from non-0 to 0-scores for SSCE GL-3 were significant at years 1, 3, and 5, but results were variable. Plasma GL-3 normalized and urine GL-3 reduced substantially. Higher anti-agalsidase beta antibody titers were associated with less robust SSCE GL-3 clearance and higher urine GL-3 levels. Renal function remained stable and normal. Most Fabry signs and symptoms tended to stabilize; abdominal pain was significantly reduced (-26.3%; P = .0215). No new clinical major organ complications were observed. GL-3 accumulation and cellular and vascular injury were present in baseline kidney biopsies (n = 7). Treatment effects on podocyte GL-3 content and foot process width were highly variable. Fabry arteriopathy overall increased in severity. Two patients withdrew and 2 had their agalsidase beta dose increased. CONCLUSIONS Our findings increase the limited amount of available data on long-term effects of enzyme replacement therapy in pediatric, classic Fabry patients. The low-dose regimens studied here over a period of 5 years did not demonstrate a consistent benefit among the patients in terms of controlling symptomatology, urine GL-3 levels, and pathological histology. The current available evidence supports treatment of pediatric, classic male Fabry patients at the approved agalsidase beta dose of 1.0 mg/kg 2-weekly if these patients are considered for enzyme replacement therapy with agalsidase beta.
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Affiliation(s)
- Uma Ramaswami
- Lysosomal Disorders Unit, Institute of Immunity and Transplantation, Royal Free London NHS Foundation Trust, University College of London, London, United Kingdom.
| | - Daniel G Bichet
- Nephrology Service, Research Center, Hôpital du Sacré-Coeur de Montréal and University of Montreal, Montreal, QC, Canada
| | - Lorne A Clarke
- Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Gabriela Dostalova
- 2nd Department of Internal Medicine and Department of Cardiovascular Medicine, Charles University Prague, General University Hospital Prague, Prague, Czech Republic
| | - Alejandro Fainboim
- Hospital de Niños Ricardo Gutierrez, Hospital de Dia Polivalente, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Andreas Fellgiebel
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Cassiano M Forcelini
- Faculty of Medicine, Universidade de Passo Fundo, and Hospital São Vicente de Paulo, Passo Fundo, RS, Brazil
| | | | - Robert J Hopkin
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College Medicine, Cincinnati, OH, USA
| | - Michael Mauer
- Departments of Pediatrics and Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Behzad Najafian
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - C Ronald Scott
- Division of Genetic Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Suma P Shankar
- Departments of Human Genetics and Ophthalmology, Emory University School of Medicine, Decatur, GA, USA
| | | | - Camilla Tøndel
- Departments of Pediatrics and Clinical Medicine, Haukeland University Hospital, Bergen, Norway
| | - Anna Tylki-Szymanska
- Department of Pediatric Nutrition and Metabolic Diseases, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - Frits A Wijburg
- Department of Pediatric Metabolic Diseases, Emma Children's Hospital and Amsterdam Lysosome Center "Sphinx", Academic Medical Center, University Hospital of Amsterdam, Amsterdam, the Netherlands
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21
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Müntze J, Gensler D, Maniuc O, Liu D, Cairns T, Oder D, Hu K, Lorenz K, Frantz S, Wanner C, Nordbeck P. Oral Chaperone Therapy Migalastat for Treating Fabry Disease: Enzymatic Response and Serum Biomarker Changes After 1 Year. Clin Pharmacol Ther 2019; 105:1224-1233. [PMID: 30506669 PMCID: PMC6590383 DOI: 10.1002/cpt.1321] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [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] [Received: 08/16/2018] [Accepted: 11/16/2018] [Indexed: 01/18/2023]
Abstract
Long‐term effects of migalastat therapy in clinical practice are currently unknown. We evaluated migalastat efficacy and biomarker changes in a prospective, single‐center study on 14 patients with Fabry disease (55 ± 14 years; 11 men). After 1 year of open‐label migalastat therapy, patients showed significant changes in alpha‐galactosidase‐A activity (0.06–0.2 nmol/minute/mg protein; P = 0.001), left ventricular myocardial mass index (137–130 g/m2; P = 0.037), and serum creatinine (0.94–1.0 mg/dL; P = 0.021), accounting for deterioration in estimated glomerular filtration rate (87–78 mL/minute/1.73 m2; P = 0.012). The enzymatic increase correlated with myocardial mass reduction (r = −0.546; P = 0.044) but not with renal function (r = −0.086; P = 0.770). Plasma globotriaosylsphingosine was reduced in therapy‐naive patients (10.9–6.0 ng/mL; P = 0.021) and stable (9.6–12.1 ng/mL; P = 0.607) in patients switched from prior enzyme‐replacement therapy. These first real‐world data show that migalastat substantially increases alpha‐galactosidase‐A activity, stabilizes related serum biomarkers, and improves cardiac integrity in male and female patients with amenable Fabry disease mutations.
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Affiliation(s)
- Jonas Müntze
- Department of Internal Medicine I and Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Daniel Gensler
- Department of Internal Medicine I and Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Octavian Maniuc
- Department of Internal Medicine I and Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Dan Liu
- Department of Internal Medicine I and Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Tereza Cairns
- Department of Internal Medicine I and Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Daniel Oder
- Department of Internal Medicine I and Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Kai Hu
- Department of Internal Medicine I and Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Kristina Lorenz
- Leibniz-Institut für Analytische Wissenschaften-ISAS-e.V., Dortmund, Germany.,West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Stefan Frantz
- Department of Internal Medicine I and Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Christoph Wanner
- Department of Internal Medicine I and Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I and Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
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22
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Oder D, Wanner C, Nordbeck P. Letter by Oder et al Regarding Article, "Early Cardiac Involvement Affects Left Ventricular Longitudinal Function in Females Carrying α-Galactosidase A Mutation: Role of Hybrid Positron Emission Tomography and Magnetic Resonance Imaging and Speckle-Tracking Echocardiography. Circ Cardiovasc Imaging 2018; 11:e007896. [PMID: 30354498 DOI: 10.1161/circimaging.118.007896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Daniel Oder
- Department of Internal Medicine I, Divisions of Cardiology and Nephrology, University Hospital Würzburg, Germany (D.O., C.W., P.N.).,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Germany (D.O., C.W., P.N.).,Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital Würzburg, Germany (D.O., C.W., P.N.)
| | - Christoph Wanner
- Department of Internal Medicine I, Divisions of Cardiology and Nephrology, University Hospital Würzburg, Germany (D.O., C.W., P.N.).,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Germany (D.O., C.W., P.N.).,Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital Würzburg, Germany (D.O., C.W., P.N.)
| | - Peter Nordbeck
- Department of Internal Medicine I, Divisions of Cardiology and Nephrology, University Hospital Würzburg, Germany (D.O., C.W., P.N.).,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Germany (D.O., C.W., P.N.).,Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital Würzburg, Germany (D.O., C.W., P.N.)
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23
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Liu D, Oder D, Salinger T, Hu K, Müntze J, Weidemann F, Herrmann S, Ertl G, Wanner C, Frantz S, Störk S, Nordbeck P. Association and diagnostic utility of diastolic dysfunction and myocardial fibrosis in patients with Fabry disease. Open Heart 2018; 5:e000803. [PMID: 30018776 PMCID: PMC6045729 DOI: 10.1136/openhrt-2018-000803] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/21/2018] [Accepted: 06/13/2018] [Indexed: 01/10/2023] Open
Abstract
Objectives Current guidelines highlight important therapy implications of cardiac fibrosis in patients with Fabry disease (FD). However, association between morphological and functional impairments with cardiac fibrosis in hereditary cardiomyopathies remains elusive. We investigated the association between echocardiography-determined cardiac dysfunction and cardiac MRI (cMRI)-detected myocardial fibrosis (late gadolinium enhancement, LE) in patients with FD with preserved left ventricular ejection fraction (≥50%). Methods 146 patients with FD (aged 39±14 years, 57 men) were analysed, all receiving echocardiography and cMRI within a 1 week interval. Longitudinal systolic strain (LS_sys), strain rate (LSr_sys) and diastolic strain rate (LSr_E/LSr_A) were assessed using speckle-tracking imaging. Receiver operating characteristic (ROC) analysis was performed to identify the diagnostic performance of various markers for LE. Results LE was detected in 57 (39%) patients with FD. LV wall thickness, left atrial volume, septal E/e', diastolic dysfunction grade, global LS_sys and E/LSr_E, mid-lateral LS_sys and LSr_E, as well as N-terminal pro-brain natriuretic peptide were all associated with LE independent of age, sex, body mass index, New York Heart Association functional class and kidney function. In ROC curve analysis, septal E/e' performed best (area under the curve=0.86, 95% CI=0.79 to 0.92). Septal E/e'>14.8 was strongly associated with LE (specificity=97.8% and sensitivity=49.1%). In 9% of patients, localised LE was present even though no other cardiac or kidney abnormalities were detected. Conclusions Echocardiography-derived diastolic dysfunction is closely linked to LE in FD. Septal E/e' ratio is the best echocardiographic marker suggestive of LE. Diastolic dysfunction is not a prerequisite for LE in FD, since LE can be detected in the absence of measurable cardiac functional impairments. Trial registration number ClinicalTrials.gov Identifier (NCT03362164).
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Affiliation(s)
- Dan Liu
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Daniel Oder
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Tim Salinger
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Kai Hu
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Jonas Müntze
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Frank Weidemann
- Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany.,Medizinische Klinik I, Klinikum Vest, Recklinghausen, Germany
| | - Sebastian Herrmann
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Georg Ertl
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Christoph Wanner
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Stefan Frantz
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Stefan Störk
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
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Oder D, Liu D, Üçeyler N, Sommer C, Hu K, Salinger T, Müntze J, Petritsch B, Ertl G, Wanner C, Nordbeck P, Weidemann F. Clinical impact of the alpha-galactosidase A gene single nucleotide polymorphism -10C>T: A single-center observational study. Medicine (Baltimore) 2018; 97:e10669. [PMID: 29794742 PMCID: PMC6392711 DOI: 10.1097/md.0000000000010669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Single nucleotide polymorphisms (SNPs) in the alpha-galactosidase A gene region (GLA) have been discussed as potential cause of symptoms and organ manifestations similarly to those seen in Fabry disease (FD). However, due to scarce data, clinical implications remain limited. The aim of the present study was to investigate the clinical impact of -10C>T SNP in the GLA.Prospective single-center observational study to determine the natural history and outcome of FD.Subjects initially referred to the Fabry Center for Interdisciplinary Therapy Würzburg (FAZIT) for management of suspected FD (11 women, 2 men, mean age 42 ± 10 years) who were tested negative for coding GLA mutations but positive for the noncoding -10C>T SNP underwent comprehensive characterization for therapy recommendation.All subjects reported at least 1 neurological, but no cardiac or renal symptoms. In 7 patients, pain of unknown etiology was reported and 3 patients had a history of cryptogenic stroke. In all patients, α-GAL activity was at a lower limit, ranging between 0.27 and 0.45 nmol/min per mg protein (reference: 0.4-1.0), while plasma Lyso-Gb3 levels remained normal (range 0.39 ± 0.33; reference: ≤0.9 ng/mL). For both hemizygous subjects investigated, brain magnetic resonance imaging revealed unspecific white matter lesions. One of these subjects had suffered from severe early-onset stroke, the other showed mild hypertrophic cardiomyopathy.Presence of isolated heterozygous -10C >T SNP is not associated with clinically relevant symptoms or organ manifestations as seen in FD. Respective polymorphisms might, however, play a role in modifying disease severity in FD. Great care has to be taken in respective subjects suspected to suffer from nonclassical FD in order to prevent unnecessary Fabry-specific therapy.
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Affiliation(s)
- Daniel Oder
- Department of Internal Medicine I, Division of Cardiology and Nephrology and Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg
- Fabry Center for Interdisciplinary Therapy, University of Würzburg
| | - Dan Liu
- Department of Internal Medicine I, Division of Cardiology and Nephrology and Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg
| | - Nurcan Üçeyler
- Fabry Center for Interdisciplinary Therapy, University of Würzburg
- Department of Neurology, University Hospital Würzburg
| | - Claudia Sommer
- Fabry Center for Interdisciplinary Therapy, University of Würzburg
- Department of Neurology, University Hospital Würzburg
| | - Kai Hu
- Department of Internal Medicine I, Division of Cardiology and Nephrology and Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg
- Fabry Center for Interdisciplinary Therapy, University of Würzburg
| | - Tim Salinger
- Department of Internal Medicine I, Division of Cardiology and Nephrology and Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg
- Fabry Center for Interdisciplinary Therapy, University of Würzburg
| | - Jonas Müntze
- Department of Internal Medicine I, Division of Cardiology and Nephrology and Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg
- Fabry Center for Interdisciplinary Therapy, University of Würzburg
| | - Bernhard Petritsch
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg
| | - Georg Ertl
- Department of Internal Medicine I, Division of Cardiology and Nephrology and Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg
| | - Christoph Wanner
- Department of Internal Medicine I, Division of Cardiology and Nephrology and Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg
- Fabry Center for Interdisciplinary Therapy, University of Würzburg
| | - Peter Nordbeck
- Department of Internal Medicine I, Division of Cardiology and Nephrology and Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg
- Fabry Center for Interdisciplinary Therapy, University of Würzburg
| | - Frank Weidemann
- Department of Internal Medicine I, Division of Cardiology and Nephrology and Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg
- Fabry Center for Interdisciplinary Therapy, University of Würzburg
- Department of Medicine II, Katharinen-Hospital Unna, Unna, Germany
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25
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Lavalle L, Thomas AS, Beaton B, Ebrahim H, Reed M, Ramaswami U, Elliott P, Mehta AB, Hughes DA. Phenotype and biochemical heterogeneity in late onset Fabry disease defined by N215S mutation. PLoS One 2018; 13:e0193550. [PMID: 29621274 PMCID: PMC5886405 DOI: 10.1371/journal.pone.0193550] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/13/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Fabry disease (FD) results from X-linked inheritance of a mutation in the GLA gene, encoding for alpha galactosidase A, and is characterized by heterogeneous clinical manifestations. Two phenotypes have been described "Classic" and "late onset" which cannot be predicted exclusively by genotype. The latter has been considered an attenuated form of the disease often affecting a single organ system commonly the heart. Recent studies have demonstrated that cardiac outcomes are similar in patients with classic and late onset mutations. In this study we investigate the relationship between clinical heterogeneity and plasma lyso-Gb3 in a large single centre cohort of N215S patients and compare this to patients with other mutations. METHODS In this single-centre, retrospective, cross-sectional study we analysed a cohort of 251 FD patients: 84 N215S mutation (37 males) and 167 non-N215S mutations (58 males). The Mainz severity score index (MSSI) was used as an index of overall disease severity. Cardiac function and morphology were assessed by electrocardiogram and echocardiogram. Left ventricular mass was calculated using the Devereux formula and the left ventricular mass index (LVMI) calculated to adjust for height (g/m2.7). The presence of white matter lesions was assessed by cerebral MRI or computed tomography (CT). GFR was measured by radio-isotope (chromium-EDTA) method and adjusted for patient height (ml/min/m2.7), and urinary protein quantification was undertaken by 24 hour urine collection. Plasma globotriaosylsphingosine (lyso-Gb3) was analysed prior to ERT in 84 patients. RESULTS N215S patients showed later symptom onset (males: p< 0.0001, females: p<0.03), later development of left ventricular hypertrophy (LVH) (median survival without LVH: 41 (non-N215S) vs. 64 (N215S) years, p< 0.0001), later development of proteinuria (median survival without proteinuria 43 (non-N215S) vs 71 years (N215S), p< 0.0001), later occurrence of cerebrovascular events (stroke/ Transient Ischaemic Attacks (TIA); median survival without stroke: 74 years (non-N215S) vs. not reached (N215S), p< 0.02), later decline in renal function to GFR <60 ml/min/1.73m2 (median survival: 56 (non-N215S) vs. 72 (N215S) years, p< 0.01), and greater overall survival (median survival 81 (N215S) vs. 66 (non-N215S) years, p< 0.0006). Lyso-Gb3 was found to be less elevated in N215S compared to non-N215S male and female patients. However, the N215S population eventually reached an overall severity measured by MSSI comparable to the non-N215S without equivalent elevation of lyso-Gb3 (means: 6.7 vs. 74.3 nmol/L, p < 0.001). In addition, N215S patients showed strong correlations between lyso-Gb3 levels and LVMI, GFR, and MSSI. These associations became stronger when we investigated individuals' life time exposure to lyso-Gb3 (calculated as [lyso-Gb3]*age): MSSI (r2 = 0.88, p< 0.0001), LVMI (r2 = 0.59, p< 0.005), and GFR (r2 = 0.75, p = 0.0001). CONCLUSION These results demonstrate that the N215S mutation results in a late onset phenotype involving the heart and other organs. Correlations between clinical manifestations and plasma lyso-Gb3 variations in this group suggest a Fabry-relevant disease mechanism for the heterogeneity observed in this group.
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Affiliation(s)
- L. Lavalle
- Lysosomal Storage Disorders Unit, Department of Haematology, Royal Free Hospital and University College Medical School, London, United Kingdom
| | - A. S. Thomas
- UCL Institute of Cardiovascular Science, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - B. Beaton
- Lysosomal Storage Disorders Unit, Department of Haematology, Royal Free Hospital and University College Medical School, London, United Kingdom
| | - H. Ebrahim
- Lysosomal Storage Disorders Unit, Department of Haematology, Royal Free Hospital and University College Medical School, London, United Kingdom
| | - M. Reed
- Lysosomal Storage Disorders Unit, Department of Haematology, Royal Free Hospital and University College Medical School, London, United Kingdom
| | - U. Ramaswami
- Lysosomal Storage Disorders Unit, Department of Haematology, Royal Free Hospital and University College Medical School, London, United Kingdom
| | - P. Elliott
- Haematology Department, St George’s Hospital NHS Foundation Trust, London, United Kingdom
| | - A. B. Mehta
- Lysosomal Storage Disorders Unit, Department of Haematology, Royal Free Hospital and University College Medical School, London, United Kingdom
| | - D. A. Hughes
- Lysosomal Storage Disorders Unit, Department of Haematology, Royal Free Hospital and University College Medical School, London, United Kingdom
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Doheny D, Srinivasan R, Pagant S, Chen B, Yasuda M, Desnick RJ. Fabry Disease: prevalence of affected males and heterozygotes with pathogenic GLA mutations identified by screening renal, cardiac and stroke clinics, 1995-2017. J Med Genet 2018; 55:261-268. [PMID: 29330335 DOI: 10.1136/jmedgenet-2017-105080] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [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: 09/27/2017] [Revised: 11/29/2017] [Accepted: 12/11/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Fabry Disease (FD), an X linked lysosomal storage disease due to pathogenic α-galactosidase A (GLA) mutations, results in two major subtypes, the early-onset Type 1 'Classic' and the Type 2 'Later-Onset' phenotypes. To identify previously unrecognised patients, investigators screened cardiac, renal and stroke clinics by enzyme assays. However, some screening studies did not perform confirmatory GLA mutation analyses, and many included recently recognised 'benign/likely-benign' variants, thereby inflating prevalence estimates. METHODS Online databases were searched for all FD screening studies in high-risk clinics (1995-2017). Studies reporting GLA mutations were re-analysed for pathogenic mutations, sex and phenotype. Phenotype-specific and sex-specific prevalence rates were determined. RESULTS Of 67 studies, 63 that screened 51363patients (33943M and 17420F) and provided GLA mutations were reanalysed for disease-causing mutations. Of reported GLA mutations, benign variants occurred in 47.9% of males and 74.1% of females. The following were the revised prevalence estimates: among 36820 (23954M and 12866F) haemodialysis screenees, 0.21% males and 0.15% females; among 3074 (2031M and 1043F) renal transplant screenees, 0.25% males and no females; among 5491 (4054M and 1437F) cardiac screenees, 0.94% males and 0.90% females; and among 5978 (3904M and 2074F) stroke screenees, 0.13% males and 0.14% females. Among male and female screenees with pathogenic mutations, the type 1 Classic phenotype was predominant (~60%), except more male cardiac patients (75%) had type 2 Later-Onset phenotype. CONCLUSIONS Compared with previous findings, reanalysis of 63 studies increased the screenee numbers (~3.4-fold), eliminated 20 benign/likely benign variants, and provided more accurate sex-specific and phenotype-specific prevalence estimates, ranging from ~0.13% of stroke to ~0.9% of cardiac male or female screenees.
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Affiliation(s)
- Dana Doheny
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ram Srinivasan
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Silvere Pagant
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brenden Chen
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Makiko Yasuda
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert J Desnick
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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