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Dardis A, Michelakakis H, Rozenfeld P, Fumic K, Wagner J, Pavan E, Fuller M, Revel-Vilk S, Hughes D, Cox T, Aerts J. Patient centered guidelines for the laboratory diagnosis of Gaucher disease type 1. Orphanet J Rare Dis 2022; 17:442. [PMID: 36544230 PMCID: PMC9768924 DOI: 10.1186/s13023-022-02573-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/20/2022] [Indexed: 12/24/2022] Open
Abstract
Gaucher disease (GD) is an autosomal recessive lysosomal storage disorder due to the deficient activity of the acid beta-glucosidase (GCase) enzyme, resulting in the progressive lysosomal accumulation of glucosylceramide (GlcCer) and its deacylated derivate, glucosylsphingosine (GlcSph). GCase is encoded by the GBA1 gene, located on chromosome 1q21 16 kb upstream from a highly homologous pseudogene. To date, more than 400 GBA1 pathogenic variants have been reported, many of them derived from recombination events between the gene and the pseudogene. In the last years, the increased access to new technologies has led to an exponential growth in the number of diagnostic laboratories offering GD testing. However, both biochemical and genetic diagnosis of GD are challenging and to date no specific evidence-based guidelines for the laboratory diagnosis of GD have been published. The objective of the guidelines presented here is to provide evidence-based recommendations for the technical implementation and interpretation of biochemical and genetic testing for the diagnosis of GD to ensure a timely and accurate diagnosis for patients with GD worldwide. The guidelines have been developed by members of the Diagnostic Working group of the International Working Group of Gaucher Disease (IWGGD), a non-profit network established to promote clinical and basic research into GD for the ultimate purpose of improving the lives of patients with this disease. One of the goals of the IWGGD is to support equitable access to diagnosis of GD and to standardize procedures to ensure an accurate diagnosis. Therefore, a guideline development group consisting of biochemists and geneticists working in the field of GD diagnosis was established and a list of topics to be discussed was selected. In these guidelines, twenty recommendations are provided based on information gathered through a systematic review of the literature and two different diagnostic algorithms are presented, considering the geographical differences in the access to diagnostic services. Besides, several gaps in the current diagnostic workflow were identified and actions to fulfill them were taken within the IWGGD. We believe that the implementation of recommendations provided in these guidelines will promote an equitable, timely and accurate diagnosis for patients with GD worldwide.
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Affiliation(s)
- A. Dardis
- grid.411492.bRegional Coordinator Centre for Rare Disease, University Hospital of Udine, P.Le Santa Maria Della Misericordia 15, 33100 Udine, Italy
| | - H. Michelakakis
- grid.414709.f0000 0004 0383 4326Department of Enzymology and Cellular Function, Institute of Child Health, Athens, Greece
| | - P. Rozenfeld
- grid.9499.d0000 0001 2097 3940Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas, Instituto de Estudios Inmunológicos Y Fisiopatológicos (IIFP), UNLP, CONICET, Asociado CIC PBA, La Plata, Argentina
| | - K. Fumic
- grid.412688.10000 0004 0397 9648Department for Laboratory Diagnostics, University Hospital Centre Zagreb and School of Medicine, Zagreb, Croatia
| | - J. Wagner
- grid.412680.90000 0001 1015 399XDepartment of Medical Biology and Genetics, Faculty of Medicine, J.J. Strossmayer University, Osijek, Croatia ,International Gaucher Alliance, Dursley, UK
| | - E. Pavan
- grid.411492.bRegional Coordinator Centre for Rare Disease, University Hospital of Udine, P.Le Santa Maria Della Misericordia 15, 33100 Udine, Italy
| | - M. Fuller
- grid.1010.00000 0004 1936 7304Genetics and Molecular Pathology, SA Pathology at Women’s and Children’s Hospital and Adelaide Medical School, University of Adelaide, Adelaide, SA 5005 Australia
| | - S. Revel-Vilk
- grid.415593.f0000 0004 0470 7791Gaucher Unit, Shaare Zedek Medical Center, Jerusalem, Israel ,grid.9619.70000 0004 1937 0538Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - D. Hughes
- grid.437485.90000 0001 0439 3380Lysosomal Storage Disorders Unit, Royal Free London NHS Foundation Trust and University College London, London, UK
| | - T. Cox
- grid.5335.00000000121885934Department of Medicine, University of Cambridge, Cambridge, UK
| | - J. Aerts
- grid.5132.50000 0001 2312 1970Department of Medical Biochemistry, Leiden Institute of Chemistry, Leiden, The Netherlands
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Moreno-Martinez D, Aguiar P, Auray-Blais C, Beck M, Bichet DG, Burlina A, Cole D, Elliott P, Feldt-Rasmussen U, Feriozzi S, Fletcher J, Giugliani R, Jovanovic A, Kampmann C, Langeveld M, Lidove O, Linhart A, Mauer M, Moon JC, Muir A, Nowak A, Oliveira JP, Ortiz A, Pintos-Morell G, Politei J, Rozenfeld P, Schiffmann R, Svarstad E, Talbot AS, Thomas M, Tøndel C, Warnock D, West ML, Hughes DA. Standardising clinical outcomes measures for adult clinical trials in Fabry disease: A global Delphi consensus. Mol Genet Metab 2021; 132:234-243. [PMID: 33642210 DOI: 10.1016/j.ymgme.2021.02.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Recent years have witnessed a considerable increase in clinical trials of new investigational agents for Fabry disease (FD). Several trials investigating different agents are currently in progress; however, lack of standardisation results in challenges to interpretation and comparison. To facilitate the standardisation of investigational programs, we have developed a common framework for future clinical trials in FD. METHODS AND FINDINGS A broad consensus regarding clinical outcomes and ways to measure them was obtained via the Delphi methodology. 35 FD clinical experts from 4 continents, representing 3389 FD patients, participated in 3 rounds of Delphi procedure. The aim was to reach a consensus regarding clinical trial design, best treatment comparator, clinical outcomes, measurement of those clinical outcomes and inclusion and exclusion criteria. Consensus results of this initiative included: the selection of the adaptative clinical trial as the ideal study design and agalsidase beta as ideal comparator treatment due to its longstanding use in FD. Renal and cardiac outcomes, such as glomerular filtration rate, proteinuria and left ventricular mass index, were prioritised, whereas neurological outcomes including cerebrovascular and white matter lesions were dismissed as a primary or secondary outcome measure. Besides, there was a consensus regarding the importance of patient-related outcomes such as general quality of life, pain, and gastrointestinal symptoms. Also, unity about lysoGb3 and Gb3 tissue deposits as useful surrogate markers of the disease was obtained. The group recognised that cardiac T1 mapping still has potential but requires further development before its widespread introduction in clinical trials. Finally, patients with end-stage renal disease or renal transplant should be excluded unless a particular group for them is created inside the clinical trial. CONCLUSION This consensus will help to shape the future of clinical trials in FD. We note that the FDA has, coincidentally, recently published draft guidelines on clinical trials in FD and welcome this contribution.
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Affiliation(s)
- D Moreno-Martinez
- Lysosomal Storage Disorders Unit, Royal Free Hospital NHS Foundation Trust and University College London, London, UK
| | - P Aguiar
- Inborn Errors of Metabolism Reference Centre, North Lisbon Hospital Centre, Lisbon, Portugal
| | - C Auray-Blais
- Division of Medical Genetics, Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - M Beck
- Institute of Human Genetics, University Medical Centre, University of Mainz, Mainz, Germany
| | - D G Bichet
- Unité de Recherche Clinique, Centre de Recherche et Service de Néphrologie, Hôpital du Sacré-Coeur de Montreal, Montreal, Quebec, Canada
| | - A Burlina
- Neurological Unit, St. Bassiano Hospital, Bassano del Grappa, Italy
| | - D Cole
- Department of Medical Biochemistry and Immunology, University Hospital of Wales, Cardiff, Wales, UK
| | - P Elliott
- Barts Cardiac Centre, University College London, London, UK
| | - U Feldt-Rasmussen
- Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen, Denmark
| | - S Feriozzi
- Division of Nephrology, Belcolle Hospital, Viterbo, Italy
| | - J Fletcher
- Genetics and Molecular Pathology, SA Pathology Women's and Children's Hospital, North Adelaide, Australia
| | - R Giugliani
- Medical Genetics Service, HCPA, Department of Genetics, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - A Jovanovic
- Department of Endocrinology and Metabolic Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - C Kampmann
- Centre for Paediatric and Adolescent Medicine, University Medical Centre, University of Mainz, Mainz, Germany
| | - M Langeveld
- Department of Endocrinology and Metabolism, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - O Lidove
- Department of Internal Medicine, Université Paris 7, Hôpital Bichat Claude-Bernard, Paris, France
| | - A Linhart
- Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - M Mauer
- Department of Paediatrics, University of Minnesota, Minneapolis, MN, United States
| | - J C Moon
- Cardiac Imaging Department, Barts Heart Centre, London, UK
| | - A Muir
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, UK
| | - A Nowak
- Department of Endocrinology and Clinical Nutrition, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - J P Oliveira
- Service of Medical Genetics, São João University Hospital Centre, Alameda Hernãni Monteiro, Porto, Portugal
| | - A Ortiz
- Fundación Jiménez Díaz (IIS-FJD) Área de Patología Cardiovascular, Renal e Hipertensión, Madrid, Spain
| | - G Pintos-Morell
- Rare and Metabolic Diseases Unit, Vall Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Politei
- Fundation for the Study of Neurometabolic Diseases, FESEN, Argentina
| | - P Rozenfeld
- Departamento de Ciencias Biológicas, CONICET, Facultad de Ciencias Exactas, IIFP, Universidad Nacional de La Plata, La Plata, Argentina
| | - R Schiffmann
- Institute of Metabolic Disease, Baylor Research Institute, Dallas, TX, USA
| | - E Svarstad
- Department of Clinical Medicine, University of Bergen and Haukeland University Hospital, Bergen, Norway
| | - A S Talbot
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - M Thomas
- Department of Nephrology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - C Tøndel
- Clinical Trials Unit, Haukeland University Hospital, Bergen, Norway
| | - D Warnock
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M L West
- Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - D A Hughes
- Lysosomal Storage Disorders Unit, Royal Free Hospital NHS Foundation Trust and University College London, London, UK.
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Reisin RC, Rozenfeld P, Bonardo P. Fabry disease patients have an increased risk of stroke in the COVID-19 ERA. A hypothesis. Med Hypotheses 2020; 144:110282. [PMID: 33254586 PMCID: PMC7494494 DOI: 10.1016/j.mehy.2020.110282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/13/2020] [Indexed: 01/04/2023]
Abstract
Stroke is a severe and frequent complication of Fabry disease (FD), affecting both males and females. Cerebrovascular complications are the end result of multiple and complex pathophysiology mechanisms involving endothelial dysfunction and activation, development of chronic inflammatory cascades leading to a prothrombotic state in addition to cardioembolic stroke due to cardiomyopathy and arrhythmias. The recent coronavirus disease 2019 outbreak share many overlapping deleterious pathogenic mechanisms with those of FD and therefore we analyze the available information regarding the pathophysiology mechanisms of both disorders and hypothesize that there is a markedly increased risk of ischemic and hemorrhagic cerebrovascular complications in Fabry patients suffering from concomitant SARS-CoV-2 infections.
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Affiliation(s)
- R C Reisin
- Neurology Service Hospital Britanico de Buenos Aires, Argentina; AADELFA Asociación Argentina de Estudio de Enfermedad de Fabry y otras Enfermedades Lisosomales.
| | - P Rozenfeld
- AADELFA Asociación Argentina de Estudio de Enfermedad de Fabry y otras Enfermedades Lisosomales; Instituto de Estudios Inmunológicos y Fisiopatológicos (IIFP), UNLP, CONICET, asociado CIC PBA, Facultad de Ciencias Exactas, Departamento de Ciencias Biológicas, La Plata, Argentina
| | - P Bonardo
- Neurology Service Hospital Britanico de Buenos Aires, Argentina
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Bondar C, Mucci J, Crivaro A, Ormazabal M, Ceci R, Oliveri B, González D, Rozenfeld P. In vitro osteoclastogenesis from Gaucher patients' cells correlates with bone mineral density but not with Chitotriosidase. Bone 2017; 103:262-269. [PMID: 28736246 DOI: 10.1016/j.bone.2017.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 01/31/2017] [Revised: 06/06/2017] [Accepted: 07/19/2017] [Indexed: 01/18/2023]
Abstract
Gaucher disease (GD) is caused by mutations on the gene encoding for the lysosomal enzyme glucocerebrosidase. Type I GD (GD1) patients present anemia, hepatosplenomegaly and bone alterations. In spite of treatment, bone alterations in GD patients persist, including poor bone mineral density (BMD). Mechanisms leading to bone damage are not completely understood, but previous reports suggest that osteoclasts are involved. Chitotriosidase (CHIT) is the most reliable biomarker used in the follow up of patients, although its correlation with bone status is unknown. The aim of this work was to study the pro-osteoclastogenic potential in patients and to evaluate its correlation with CHIT activity levels and clinical parameters. PBMCs from treated patients and healthy controls were cultured in the presence of M-CSF, and mature osteoclasts were counted. BMD, blood CHIT activity and serum levels of CTX, BAP, and cytokines were evaluated in patients. We found that blood CHIT activity and osteoclast differentiation were significantly increased in patients, but no correlation between them was observed. Interestingly, osteoclast numbers but not CHIT, presented a negative correlation with BMD expressed as Z-score. CTX, BAP and serum cytokines involved in bone remodeling were found altered in GD1 patients. These results show for the first time a correlation between osteoclast differentiation and BMD in GD1 patients, supporting the involvement of osteoclasts in the bone pathology of GD1. Our results also suggest that an altered immune response may play an important role in bone damage.
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Affiliation(s)
- C Bondar
- IIFP, Universidad Nacional de La Plata, CONICET, Facultad de Ciencias Exactas, Departamento de Ciencias Biológicas, 47 y 115, 1900 La Plata, Argentina
| | - J Mucci
- IIFP, Universidad Nacional de La Plata, CONICET, Facultad de Ciencias Exactas, Departamento de Ciencias Biológicas, 47 y 115, 1900 La Plata, Argentina
| | - A Crivaro
- IIFP, Universidad Nacional de La Plata, CONICET, Facultad de Ciencias Exactas, Departamento de Ciencias Biológicas, 47 y 115, 1900 La Plata, Argentina
| | - M Ormazabal
- IIFP, Universidad Nacional de La Plata, CONICET, Facultad de Ciencias Exactas, Departamento de Ciencias Biológicas, 47 y 115, 1900 La Plata, Argentina
| | - R Ceci
- IIFP, Universidad Nacional de La Plata, CONICET, Facultad de Ciencias Exactas, Departamento de Ciencias Biológicas, 47 y 115, 1900 La Plata, Argentina
| | - B Oliveri
- Laboratorio de Osteoporosis y Enfermedades Metabólicas Óseas. Instituto de inmunología, Genética y Metabolismo (INIGEM) CONICET-UBA Hospital de Clínicas, Buenos Aires, Argentina
| | - D González
- Mautalen, Salud e Investigación, Bs As, Argentina
| | - P Rozenfeld
- IIFP, Universidad Nacional de La Plata, CONICET, Facultad de Ciencias Exactas, Departamento de Ciencias Biológicas, 47 y 115, 1900 La Plata, Argentina.
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Amartino H, Ceci R, Masllorens F, Gal A, Arberas C, Bay L, Ilari R, Dipierri J, Specola N, Cabrera A, Rozenfeld P. Identification of 17 novel mutations in 40 Argentinean unrelated families with mucopolysaccharidosis type II (Hunter syndrome). Mol Genet Metab Rep 2014; 1:401-406. [PMID: 27896113 PMCID: PMC5121352 DOI: 10.1016/j.ymgmr.2014.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 08/25/2014] [Accepted: 08/26/2014] [Indexed: 11/15/2022] Open
Abstract
Mucopolysaccharidosis type II (MPSII) is an X-linked lysosomal storage disorder caused by deficiency of the enzyme iduronate-2-sulfatase (IDS). The human IDS gene is located in chromosome Xq28. This is the first report of genotype and phenotype characterization of 49 Hunter patients from 40 families of Argentina. Thirty different alleles have been identified, and 57% were novel. The frequency of de novo mutations was 10%. Overall, the percentage of private mutations in our series was 75%.
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Affiliation(s)
- H Amartino
- Hospital Universitario Austral, Pilar, Argentina
| | - R Ceci
- IIFP, Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas, Universidad Nacional de La Plata y CONICET, Argentina
| | | | | | - C Arberas
- Hospital de Niños Dr Ricardo Gutierrez, Buenos Aires, Argentina
| | - L Bay
- Hospital Garrahan, Buenos Aires, Argentina
| | - R Ilari
- Policlínico Bancario, Buenos Aires, Argentina
| | - J Dipierri
- Universidad Nacional de Jujuy, Argentina
| | - N Specola
- Hospital de Niños Sor María Ludovica, La Plata, Argentina
| | - A Cabrera
- Hospital de Niños VJ Vilela, Rosario, Argentina
| | - P Rozenfeld
- IIFP, Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas, Universidad Nacional de La Plata y CONICET, Argentina
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Rozenfeld P, Agriello E, De Francesco N, Martinez P, Fossati C. Leukocyte perturbation associated with Fabry disease. J Inherit Metab Dis 2009; 32 Suppl 1:S67-77. [PMID: 19259782 DOI: 10.1007/s10545-009-1060-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 01/09/2009] [Accepted: 01/13/2009] [Indexed: 11/28/2022]
Abstract
Fabry disease is an X-linked lysosomal storage disorder of glycosphingolipid catabolism due to the deficient activity of the enzyme alpha-galactosidase A. The non-degraded substrate, mainly globotriaosylceramide (Galα1-4Galβ1-4Glcβ1-1Cer; Gb(3)) accumulates progressively in the lysosome of various cells. The aim of this work was to analyse changes in leukocyte subpopulations and surface markers and to determine whether Gb(3) is increased in leukocytes of patients with untreated and treated Fabry disease. Blood samples obtained from 22 male Fabry patients (11 untreated and 11 on enzyme replacement therapy) and 22 normal controls were subjected to flow cytometric analysis of Gb(3) intracellular content, leukocyte subpopulations and cell markers. Based on the fluorescence intensity of bound monoclonal antibody, and relative to normal control leukocytes, Gb(3) appeared significantly increased in lymphocytes (but not in monocytes or granulocytes) from patients with Fabry disease. A significantly higher percentage of lymphocytes and CD19(+) cells and a reduced proportion of monocytes, CD8(+) cells and myeloid dendritic cells were detected in samples from Fabry patients compared with normal controls. CD1d expression was significantly lower and MHC class II surface expression was significantly higher in monocytes from Fabry patients than in normal controls. As previously observed for other adhesion molecules, the expression of CD31 (PECAM) was higher in leukocytes from Fabry patients. In conclusion, the differences recorded in this study reveal a leukocyte perturbation associated with the disease state in Fabry patients, whereas some abnormalities are less marked in treated patients.
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Affiliation(s)
- P Rozenfeld
- LISIN, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, Calle 47 y 115 (1900) La Plata, Pcia de Buenos Aires, Argentina.
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Martinez P, Aggio M, Rozenfeld P. High incidence of autoantibodies in Fabry disease patients. J Inherit Metab Dis 2007; 30:365-9. [PMID: 17458709 DOI: 10.1007/s10545-007-0513-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Revised: 02/21/2007] [Accepted: 02/26/2007] [Indexed: 10/23/2022]
Abstract
Fabry disease (FD) is an X-linked disorder of glycosphingolipid catabolism that results from a deficiency of the lysosomal enzyme alpha-galactosidase A. This defect leads to the accumulation of its substrates, mainly globotriaosylceramide, in lysosomes of cells of different tissues. Different studies have shown the involvement of immunopathologies in different sphingolipidoses. The coexistence of FD and immune disorders such as systemic lupus erythematosus, rheumatoid arthritis and IgA nephropathy, has been described in the literature. The aim of this study was to evaluate the prevalence of a group of autoantibodies in a series of Argentine FD patients. Autoantibodies against extractable nuclear antigens (ENAs), double-stranded DNA, anticardiolipin and phosphatidylserine were assayed by ELISA. Lupus anticoagulants were also tested. Fifty-seven per cent of the samples showed reactivity with at least one autoantigen. Such reactivities were more frequent among males than among females. Antiphospholipid autoantibodies were detected in 45% of our patients. The high rate of thrombosis associated with FD could be related, at least in part, to the presence of antiphospholipid autoantibodies in Fabry patients. We found the presence of ENAs, which are a characteristic finding of rheumatological diseases, previous a frequent misdiagnosis of FD, in around 39% of the cases. The detection of a high level of autoantibodies must be correlated clinically to determine the existence of an underlying autoimmune disease. With the recent development of therapy, the life expectancy in FD will increase and autoimmune diseases might play an important role in the morbidity of FD.
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Affiliation(s)
- P Martinez
- Servicio de Hematología, Hospital Penna, Bahía Blanca, Argentina
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Rozenfeld P, Docena GH, Añón MC, Fossati CA. Detection and identification of a soy protein component that cross-reacts with caseins from cow's milk. Clin Exp Immunol 2002; 130:49-58. [PMID: 12296853 PMCID: PMC1906491 DOI: 10.1046/j.1365-2249.2002.t01-1-01935.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2002] [Indexed: 11/20/2022] Open
Abstract
Soy-based formulas are the most employed cow's milk substitutes in the treatment of cow's milk allergy in our country. Since adverse reactions have been reported in allergic patients as a consequence of exposure to soy proteins, we have investigated the possible cross-reactivity between components from soybean and cow's milk. A cow's milk specific polyclonal antiserum and casein specific monoclonal antibodies were used in immunoblotting and competitive ELISA studies to identify a 30-kD component from soybean that cross-reacts with cow's milk caseins. Its IgE binding capacity was tested by EAST, employing sera from cow's milk allergic patients, not previously exposed to soy proteins. The 30 kD protein was isolated and partially sequenced. It is constituted by two polypeptides (A5 and B3) linked by a disulphide bond. The protein's capacity to bind to the different antibodies relies on the B3 poly-peptide. These results indicate that soy-based formula, which contains the A5-B3 glycinin molecule, could be involved in allergic reactions observed in cow's milk allergic patients exposed to soy-containing foods.
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Affiliation(s)
- P Rozenfeld
- Cátedra de Inmunología, Facultad de Ciencias Exactas, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Argentina.
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9
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Abstract
BACKGROUND This study aimed the to investigate presence of residual allergenic cow's milk proteins (CMP) in some milk substitutes employed in the treatment of cow's milk allergy (CMA). These allergens may interfere with the treatment, and elicit allergic reactions in sensitized individuals. METHODS The protein composition of the different extracts was evaluated by Lowry's method and tricine SDS-PAGE. Different immunoenzymatic methods were used (ELISA, EAST and immunoblotting) to quantify total serum IgE and specific serum IgE, as well as to detect the presence of antigenic and allergenic components. RESULTS The results showed a higher protein content in mammalian milks (cow, sheep, mare, goat, and human) than in hydrolyzed substitutes (partially or extensively hydrolyzed casein or whey proteins). Residual native, processed, or contaminant polypeptides have been identified in the moderate hydrolysates, whereas extensive hydrolysates did not show the presence of residual components by immunoblotting. However, specific antibodies with capacity to bind to peptides have been detected by EAST and ELISA, suggesting that extensive hydrolysates contain residual peptides that preserve immunoreactive epitopes. We were unable to demonstrate either residual antigenicity or allergenicity in an amino-acid-based formula. CONCLUSIONS Immunoenzymatic methods were used to detect the presence of cross-reactive components in mammalian milks. Residual allergenic components from cow's milk could be identified in both the moderate and extensive hydrolysates analyzed. This information may be relevant to the treatment of CMA.
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Affiliation(s)
- G Docena
- Cátedra de Inmunología, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Argentina
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