1
|
Tsukimura T, Saito K, Shiga T, Ogawa Y, Sakuraba H, Togawa T. Does administration of hydroxychloroquine/amiodarone affect the efficacy of enzyme replacement therapy for Fabry mice? Mol Genet Metab Rep 2024; 39:101079. [PMID: 38601121 PMCID: PMC11004688 DOI: 10.1016/j.ymgmr.2024.101079] [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: 03/23/2024] [Accepted: 03/29/2024] [Indexed: 04/12/2024] Open
Abstract
As a standard therapy for Fabry disease, enzyme replacement therapy (ERT) with recombinant human α-galactosidase A (α-Gal) has been successfully used, and the instructions for this drug state that "it should not be co-administrated with cationic amphiphilic drugs such as hydroxychloroquine (HCQ) and amiodarone (AMI), since these drugs have the potential to inhibit intracellular α-Gal activity". However, there would be cases in which HCQ or AMI is required for patients with Fabry disease, considering their medical efficacy and application. Thus, we examined the impact of HCQ/AMI on recombinant human α-Gal by in vitro, cellular, and animal experiments. The results revealed that HCQ/AMI affected the enzyme activity of α-Gal incorporated into cultured fibroblasts from a Fabry mouse when the cells were cultured in medium containing these drugs and the enzyme, although their direct inhibitory effect on the enzyme is not strong. These lysosomotropic drugs may be trapped and concentrated in lysosomes, followed by inhibition of α-Gal. On the other hand, no reduction of α-Gal activity incorporated into the organs and tissues, or acceleration of glycoshingolipid accumulation was observed in Fabry mice co-administered with HCQ/AMI and the enzyme, compared with in the case of usual ERT. As HCQ/AMI administered are catabolized in the liver, these drugs possibly do not affect ERT for Fabry mice, different from in the case of cultured cells in an environment isolated from the surroundings.
Collapse
Affiliation(s)
- Takahiro Tsukimura
- Department of Functional Bioanalysis, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Koki Saito
- Department of Functional Bioanalysis, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Tomoko Shiga
- Department of Clinical Genetics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Yasuhiro Ogawa
- Department of Pharmacodynamics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Hitoshi Sakuraba
- Department of Clinical Genetics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Tadayasu Togawa
- Department of Functional Bioanalysis, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| |
Collapse
|
2
|
Breyer M, Grüner J, Klein A, Finke L, Klug K, Sauer M, Üçeyler N. In vitro characterization of cells derived from a patient with the GLA variant c.376A>G (p.S126G) highlights a non-pathogenic role in Fabry disease. Mol Genet Metab Rep 2024; 38:101029. [PMID: 38469097 PMCID: PMC10926200 DOI: 10.1016/j.ymgmr.2023.101029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 03/13/2024] Open
Abstract
Fabry disease (FD) is a life-limiting disorder characterized by intracellular globotriaosylceramide (Gb3) accumulations. The underlying α-galactosidase A (α-GAL A) deficiency is caused by variants in the gene GLA. Variants of unknown significance (VUS) are frequently found in GLA and challenge clinical management. Here, we investigated a 49-year old man with cryptogenic lacunar cerebral stroke and the chance finding of the VUS S126G, who was sent to our center for diagnosis and initiation of a costly and life-long FD-specific treatment. We combined clinical examination with in vitro investigations of dermal fibroblasts (HDF), induced pluripotent stem cells (iPSC), and iPSC-derived sensory neurons. We analyzed α-GAL A activity in iPSC, Gb3 accumulation in all three cell types, and action potential firing in sensory neurons. Neurological examination and small nerve fiber assessment was normal except for reduced distal skin innervation. S126G iPSC showed normal α-GAL A activity compared to controls and no Gb3 deposits were found in all three cell types. Baseline electrophysiological characteristics of S126G neurons showed no difference compared to healthy controls as investigated by patch-clamp recordings. We pioneer multi-level cellular characterization of the VUS S126G using three cell types derived from a patient and provide further evidence for the benign nature of S126G in GLA, which is of great importance in the management of such cases in clinical practice.
Collapse
Affiliation(s)
- Maximilian Breyer
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany
| | - Julia Grüner
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany
| | - Alexandra Klein
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany
| | - Laura Finke
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany
| | - Katharina Klug
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany
| | - Markus Sauer
- Department of Biophysics and Biotechnology, Biocenter, University of Würzburg, 97074 Würzburg, Germany
| | - Nurcan Üçeyler
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany
- Würzburg Fabry Center for Interdisciplinary Therapy (FAZIT), University of Würzburg, 97080 Würzburg, Germany
| |
Collapse
|
3
|
Rodríguez Doyágüez P, Furlano M, Ars Criach E, Arce Y, Guirado L, Torra Balcells R. Correlation of X chromosome inactivation with clinical presentation of Fabry disease in a case report. Nefrologia 2023; 43 Suppl 2:91-95. [PMID: 38278716 DOI: 10.1016/j.nefroe.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 12/09/2022] [Indexed: 01/28/2024] Open
Abstract
Fabry disease or also called Anderson-Fabry disease (FD) is a rare disease caused by pathogenic variants in the GLA gene, located on the X chromosome. This gene is involved in the metabolism of glycosphingolipids and its pathogenic variants cause a deficit or absence of α-galactosidase A causing the deposition of globotriaosylceramide throughout the body. Females have a variable phenotypic expression and a better prognosis than males. This is due to the X chromosome inactivation phenomenon. We present a clinical case of Fabry disease in a female with predominantly renal involvement and demonstrate how the X chromosome inactivation phenomenon is tissue dependent, showing preferential inactivation of the mutated allele at the renal level.
Collapse
Affiliation(s)
- Pablo Rodríguez Doyágüez
- Sección de Nefrología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Mónica Furlano
- Enfermedades Renales Hereditarias, Servicio de Nefrologia, Fundació Puigvert, Institut d'Investigació Biomèdica Sant Pau (IIB-SANT PAU), Universidad Autónoma Barcelona, Barcelona, Spain
| | - Elisabet Ars Criach
- Laboratorio de Biología Molecular, Fundació Puigvert, Institut d'Investigació Biomèdica Sant Pau (IIB-SANT PAU), Barcelona, Spain
| | - Yolanda Arce
- Sección de Anatomía Patológica, Fundació Puigvert, Barcelona, Spain
| | - Lluís Guirado
- Servicio de Nefrología, Fundació Puigvert, Institut d'Investigació Biomèdica Sant Pau (IIB-SANT PAU), Universidad Autónoma Barcelona, Universitat Central de Catalunya (UVIC), Barcelona, Spain
| | - Roser Torra Balcells
- Enfermedades Renales Hereditarias, Servicio de Nefrologia, Fundació Puigvert, Institut d'Investigació Biomèdica Sant Pau (IIB-SANT PAU), Universidad Autónoma Barcelona, Barcelona, Spain.
| |
Collapse
|
4
|
Shen JS, Balaji U, Shigeyasu K, Okugawa Y, Jabbarzadeh-Tabrizi S, Day TS, Arning E, Marshall J, Cheng SH, Gu J, Schiffmann R, Bottiglieri T, Goel A. Dysregulated DNA methylation in the pathogenesis of Fabry disease. Mol Genet Metab Rep 2022; 33:100919. [PMID: 36186841 PMCID: PMC9519376 DOI: 10.1016/j.ymgmr.2022.100919] [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: 08/29/2022] [Accepted: 09/21/2022] [Indexed: 12/05/2022] Open
Abstract
Fabry disease is an X-linked lysosomal storage disorder caused by a deficiency of α-galactosidase A and subsequent accumulation of glycosphingolipids with terminal α-D-galactosyl residues. The molecular process through which this abnormal metabolism of glycosphingolipids causes multisystem dysfunction in Fabry disease is not fully understood. We sought to determine whether dysregulated DNA methylation plays a role in the development of this disease. In the present study, using isogenic cellular models derived from Fabry patient endothelial cells, we tested whether manipulation of α-galactosidase A activity and glycosphingolipid metabolism affects DNA methylation. Bisulfite pyrosequencing revealed that changes in α-galactosidase A activity were associated with significantly altered DNA methylation in the androgen receptor promoter, and this effect was highly CpG loci-specific. Methylation array studies showed that α-galactosidase A activity and glycosphingolipid levels were associated with differential methylation of numerous CpG sites throughout the genome. We identified 15 signaling pathways that may be susceptible to methylation alterations in Fabry disease. By incorporating RNA sequencing data, we identified 21 genes that have both differential mRNA expression and methylation. Upregulated expression of collagen type IV alpha 1 and alpha 2 genes correlated with decreased methylation of these two genes. Methionine levels were elevated in Fabry patient cells and Fabry mouse tissues, suggesting that a perturbed methionine cycle contributes to the observed dysregulated methylation patterns. In conclusion, this study provides evidence that α-galactosidase A deficiency and glycosphingolipid storage may affect DNA methylation homeostasis and highlights the importance of epigenetics in the pathogenesis of Fabry disease and, possibly, of other lysosomal storage disorders.
Collapse
Affiliation(s)
- Jin-Song Shen
- Institute of Metabolic Disease, Baylor Scott & White Research Institute, 3434 Live Oak Street, Dallas, TX 75024, United States of America
- Corresponding author at: 4D Molecular Therapeutics, 5858 Horton St., Suite 455, Emeryville, CA 94608, United States of America.
| | - Uthra Balaji
- Baylor Scott & White Research Institute, Biostatistics, Dallas, TX, United States of America
| | - Kunitoshi Shigeyasu
- Center for Gastrointestinal Research; Center for Epigenetics, Cancer Prevention and Cancer Genomics, Baylor Research Institute, Dallas, TX, United States of America
| | - Yoshinaga Okugawa
- Center for Gastrointestinal Research; Center for Epigenetics, Cancer Prevention and Cancer Genomics, Baylor Research Institute, Dallas, TX, United States of America
| | - Siamak Jabbarzadeh-Tabrizi
- Institute of Metabolic Disease, Baylor Scott & White Research Institute, 3434 Live Oak Street, Dallas, TX 75024, United States of America
| | - Taniqua S. Day
- Institute of Metabolic Disease, Baylor Scott & White Research Institute, 3434 Live Oak Street, Dallas, TX 75024, United States of America
| | - Erland Arning
- Institute of Metabolic Disease, Baylor Scott & White Research Institute, 3434 Live Oak Street, Dallas, TX 75024, United States of America
| | - John Marshall
- Sanofi Genzyme, 49 New York Avenue, Framingham, MA 01701, United States of America
| | - Seng H. Cheng
- Sanofi Genzyme, 49 New York Avenue, Framingham, MA 01701, United States of America
| | - Jinghua Gu
- Baylor Scott & White Research Institute, Biostatistics, Dallas, TX, United States of America
| | - Raphael Schiffmann
- Institute of Metabolic Disease, Baylor Scott & White Research Institute, 3434 Live Oak Street, Dallas, TX 75024, United States of America
| | - Teodoro Bottiglieri
- Institute of Metabolic Disease, Baylor Scott & White Research Institute, 3434 Live Oak Street, Dallas, TX 75024, United States of America
| | - Ajay Goel
- Center for Gastrointestinal Research; Center for Epigenetics, Cancer Prevention and Cancer Genomics, Baylor Research Institute, Dallas, TX, United States of America
| |
Collapse
|
5
|
Varela-Calais P, Nicolicht P, Paulo Martin R, Yamamoto J, D'Almeida V, Maria Martins A, Bosco Pesquero J. Functional characterization of novel variants found in patients with suspected Fabry disease. Clin Chim Acta 2022; 534:156-160. [PMID: 35870541 DOI: 10.1016/j.cca.2022.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/17/2022] [Indexed: 11/30/2022]
Abstract
The deficiency or absence of the lysosomal hydrolase α-Galactosidase A results in Fabry disease (FD), a rare and underdiagnosed X-linked disorder. The symptoms caused by FD have a direct relation with the variant present in the gene coding α-Galactosidase A (GLA) and enzyme residual activity, and it can vary drastically between men and women of the same family. Here, we present four novel variants found in patients with suspicion of FD. The patients were screened for FD by enzymatic activity and/or DNA sequencing, which showed four novel GLA missense variants. To confirm the potential pathogenicity of these variants, we employed site-directed mutagenesis. GLA wild-type and mutant plasmids were transfected into mammalian cells; RNA and proteins were extracted for expression and enzymatic activity analysis. The patients presented the variants p.Ile133Asn, p.Lys140Thr, p.Lys168Gln and p.Pro323Thr in the GLA. In vitro analysis showed pathogenic potential of three variants and one tolerated variant. The variants p.Ile133Asn and p.Lys168Gln showed no residual activity and, therefore, leading to classical phenotype, and the variant p.Lys140Thr, which presented 22% of residual activity, was considered a mild variant leading to non-classical phenotype. The variant p.Pro323Thr presented 66.7% of residual activity and alone, it is not enough to cause FD.
Collapse
Affiliation(s)
- Patrícia Varela-Calais
- Center for Research and Molecular Diagnostic of Genetic Diseases - Department of Biophysics, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Priscila Nicolicht
- Center for Research and Molecular Diagnostic of Genetic Diseases - Department of Biophysics, Federal University of São Paulo, São Paulo, SP, Brazil; Laboratory of Molecular Neurobiology, Universidade Federal de Sao Paulo, Department of Biochemistry, Sao Paulo, Brazil
| | - Renan Paulo Martin
- McKusick-Nathans Department of Genetic Medicine - Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joyce Yamamoto
- Department of Psychobiology, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Vânia D'Almeida
- Department of Psychobiology, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Ana Maria Martins
- Reference Center in Inborn Errors of Metabolism, Pediatrics Department, Federal University of São Paulo, São Paulo, SP, Brazil
| | - João Bosco Pesquero
- Center for Research and Molecular Diagnostic of Genetic Diseases - Department of Biophysics, Federal University of São Paulo, São Paulo, SP, Brazil.
| |
Collapse
|
6
|
Dai X, Zong X, Pan X, Lu W, Jiang GR, Lin F. Identification and functional characterization of the first deep intronic GLA mutation (IVS4+1326C>T) causing renal variant of Fabry disease. Orphanet J Rare Dis 2022; 17:237. [PMID: 35725559 PMCID: PMC9208104 DOI: 10.1186/s13023-022-02377-8] [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: 01/14/2022] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fabry disease (FD, OMIM #301500) is an X-linked lysosomal disorder caused by the deficiency of α-galactosidase A (α-GalA), encoded by the GLA gene. Among more than 1100 reported GLA mutations, few were deep intronic mutations which have been linked to classic and cardiac variants of FD. METHODS AND RESULTS We report a novel hemizygous deep intronic GLA mutation (IVS4+1326C>T) in a 33-year-old Chinese man with a mild α-GalA deficiency phenotype involving isolated proteinuria and predominant globotriaosylceramide deposits in podocytes. IVS4+1326C>T, which appears to be the first deep intronic GLA mutation associated with renal variant of FD, was identified by Sanger sequencing the entire GLA genomic DNA sequence of the patient's peripheral mononuclear blood lymphocytes (PBMCs). Further sequencing of cDNA from PBMCs of the patient revealed a minor full-length GLA transcript accounting for about 25% of total GLA transcript, along with two major aberrantly spliced GLA transcripts encoding mutant forms of α-GalA with little enzyme activity characterized by in vitro α-GalA overexpression system in the HEK293T cells. Thus, the combined clinical phenotype, genetic analysis and functional studies verified the pathogenicity of IVS4+1326C>T. CONCLUSIONS The identification of IVS4+1326C>T establishes a link between deep intronic GLA mutation and the renal variant of FD, which extends the mutation spectrum in GLA gene and justifies further study of how IVS4+1326C>T and potentially other deep intronic GLA mutations contribute to Fabry podocytopathy through aberrant splicing. Future studies should also assess the true incidence of IVS4+1326C>T in patients with different variants of FD, which may improve early genetic diagnosis to allow timely treatment that can prevent disease progression and improve survival.
Collapse
Affiliation(s)
- Xuantong Dai
- Renal Division, Department of Internal Medicine, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Xue Zong
- Renal Division, Department of Internal Medicine, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Xiaoxia Pan
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200020, China
| | - Wei Lu
- Renal Division, Department of Internal Medicine, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Geng-Ru Jiang
- Renal Division, Department of Internal Medicine, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.,Centre for Rare Disease, Shanghai, 200092, China
| | - Fujun Lin
- Renal Division, Department of Internal Medicine, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China. .,Centre for Rare Disease, Shanghai, 200092, China.
| |
Collapse
|
7
|
Tsukimura T, Shiga T, Saito K, Ogawa Y, Sakuraba H, Togawa T. Does administration of hydroxychloroquine/amiodarone accelerate accumulation of globotriaosylceramide and globotriaosylsphingosine in Fabry mice? Mol Genet Metab Rep 2021; 28:100773. [PMID: 34136356 PMCID: PMC8178118 DOI: 10.1016/j.ymgmr.2021.100773] [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: 04/13/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/19/2022] Open
Abstract
Drug-induced lysosomal storage disease (DILSD) caused by cationic amphiphilic drugs (CADs), which exhibits toxic manifestations and pathological findings mimicking Fabry disease (α-galactosidase A deficiency), has attracted the interests of clinicians and pathologists. Although the affected region is lysosomes in both the diseases, DILSD is characterized by intralysosomal accumulation of phospholipids and Fabry disease that of globotriaosylceramide (Gb3) and globotriaosylsphingosine (Lyso-Gb3). However, it is unknown whether administration of CADs affects the catabolism of Gb3 and Lyso-Gb3 in Fabry disease. In this study, we independently administered hydroxychloroquine/amiodarone to wild-type and Fabry mice and examined the effects of the drugs on the enzyme activity and substrates accumulated in organs and tissues. The results revealed that the administration of the drugs induced accumulation of phosphatidylcholine in both the wild-type and Fabry mice. However, reduction of α-galactosidase A activity in the organs and tissues of the wild-type mice was not found, and the storage of Gb3 and Lyso-Gb3 was not accelerated by these drugs in the Fabry mice. This suggests that hydroxychloroquine/amiodarone do not have any significant impact on the catabolism of Gb3 and Lyso-Gb3 in organs and tissues of both wild-type and Fabry mice. Effects of cationic amphiphilic drugs on the catabolism of Gb3/Lyso-Gb3 were examined. The drugs induced phospholipidosis in the wild-type and Fabry mice. The drugs did not induce reduction of α-galactosidase A activity in the wild-type mice. The drugs did not accelerate accumulation of Gb3/Lyso-gb3 in the Fabry mice.
Collapse
Key Words
- Amiodarone
- CAD, cationic amphiphilic drug
- DILSD, drug-induced lysosomal storage disease
- Drug-induced lysosomal storage disease
- Fabry disease
- Gb3, globotriaosylceramide
- Globotriaosylceramide
- Globotriaosylsphingosine
- Hydroxychloroquine
- ILV, intralysosomal luminal vesicle
- LC, liquid chromatography
- Lyso-Gb3, globotriaosylsphingosine
- MRM, multiple reaction monitoring
- MS/MS, tandem mass spectrometry
- PhC, phosphatidylcholine
- Phospholipid
- α-Gal, α-galactosidase A
- α-Galactosidase A
Collapse
Affiliation(s)
- Takahiro Tsukimura
- Department of Functional Bioanalysis, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Tomoko Shiga
- Department of Clinical Genetics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Koki Saito
- Department of Functional Bioanalysis, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Yasuhiro Ogawa
- Department of Pharmacology, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Hitoshi Sakuraba
- Department of Clinical Genetics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Tadayasu Togawa
- Department of Functional Bioanalysis, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
- Corresponding author.
| |
Collapse
|
8
|
Varela P, Carvalho G, Martin RP, Pesquero JB. Fabry disease: GLA deletion alters a canonical splice site in a family with neuropsychiatric manifestations. Metab Brain Dis 2021; 36:265-272. [PMID: 33156427 DOI: 10.1007/s11011-020-00640-0] [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: 08/12/2020] [Accepted: 10/30/2020] [Indexed: 11/26/2022]
Abstract
Fabry disease (FD) is a rare X-linked glycosphingolipidosis caused by mutations in GLA, a gene responsible for encoding α-galactosidase A, an enzyme required for degradation of glycosphingolipids, mainly globotriaosylceramide (Gb3) in all cells of the body. FD patients present a broad spectrum of clinical phenotype and many symptoms are shared with other diseases, making diagnosis challenging. Here we describe a novel GLA variant located in the 5' splice site of the intron 3, in four members of a family with neuropsychiatric symptoms. Analysis of the RNA showed the variant promotes alteration of the wild type donor site, affecting splicing and producing two aberrant transcripts. The functional characterization showed absence of enzymatic activity in cells expressing both transcripts, confirming their pathogenicity. The family presents mild signs of FD, as angiokeratoma, cornea verticillata, acroparesthesia, tinnitus, vertigo, as well as accumulation of plasma lyso-Gb3 and urinary Gb3. Interestingly, the man and two women present psychiatric symptoms, as depression or schizophrenia. Although psychiatric illnesses, especially depression, are frequently reported in patients with FD and studies have shown that the hippocampus is an affected brain structure in these patients, it is not clear whether the Gb3 accumulation in the brain is responsible for these symptoms or they are secondary. Therefore, new studies are needed to understand whether the accumulation of Gb3 could produce neuronal alterations leading to psychiatric symptoms.
Collapse
Affiliation(s)
- Patrícia Varela
- Center for Research and Molecular Diagnostic of Genetic Diseases - Department of Biophysics, Universidade Federal de São Paulo, Rua Pedro de Toledo, 669 - 9o andar, São Paulo, 04039-032, Brazil
| | - Gerson Carvalho
- Medical Genetics Unit, Hospital de Apoio de Brasília, Brasília, DF, Brazil
| | - Renan Paulo Martin
- Center for Research and Molecular Diagnostic of Genetic Diseases - Department of Biophysics, Universidade Federal de São Paulo, Rua Pedro de Toledo, 669 - 9o andar, São Paulo, 04039-032, Brazil
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - João Bosco Pesquero
- Center for Research and Molecular Diagnostic of Genetic Diseases - Department of Biophysics, Universidade Federal de São Paulo, Rua Pedro de Toledo, 669 - 9o andar, São Paulo, 04039-032, Brazil.
| |
Collapse
|
9
|
Del Tredici K, Ludolph AC, Feldengut S, Jacob C, Reichmann H, Bohl JR, Braak H. Fabry Disease With Concomitant Lewy Body Disease. J Neuropathol Exp Neurol 2020; 79:378-392. [PMID: 32016321 PMCID: PMC7092358 DOI: 10.1093/jnen/nlz139] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 11/07/2019] [Accepted: 12/15/2019] [Indexed: 12/20/2022] Open
Abstract
Although Gaucher disease can be accompanied by Lewy pathology (LP) and extrapyramidal symptoms, it is unknown if LP exists in Fabry disease (FD), another progressive multisystem lysosomal storage disorder. We aimed to elucidate the distribution patterns of FD-related inclusions and LP in the brain of a 58-year-old cognitively unimpaired male FD patient suffering from predominant hypokinesia. Immunohistochemistry (CD77, α-synuclein, collagen IV) and neuropathological staging were performed on 100-µm sections. Tissue from the enteric or peripheral nervous system was unavailable. As controls, a second cognitively unimpaired 50-year-old male FD patient without LP or motor symptoms and 3 age-matched individuals were examined. Inclusion body pathology was semiquantitatively evaluated. Although Lewy neurites/bodies were not present in the 50-year-old individual or in controls, severe neuronal loss in the substantia nigra pars compacta and LP corresponding to neuropathological stage 4 of Parkinson disease was seen in the 58-year-old FD patient. Major cerebrovascular lesions and/or additional pathologies were absent in this individual. We conclude that Lewy body disease with parkinsonism can occur within the context of FD. Further studies determining the frequencies of both inclusion pathologies in large autopsy-controlled FD cohorts could help clarify the implications of both lesions for disease pathogenesis, potential spreading mechanisms, and therapeutic interventions.
Collapse
Affiliation(s)
- Kelly Del Tredici
- Clinical Neuroanatomy Section, Department of Neurology, Center for Biomedical Research, University of Ulm
| | | | - Simone Feldengut
- Clinical Neuroanatomy Section, Department of Neurology, Center for Biomedical Research, University of Ulm
| | - Christian Jacob
- Clinical Neuroanatomy Section, Department of Neurology, Center for Biomedical Research, University of Ulm.,Institute for Anatomy and Cell Biology, University of Ulm, Ulm
| | - Heinz Reichmann
- Department of Neurology, Dresden University of Technology, Dresden
| | - Jürgen R Bohl
- Institute of Neuropathology, University of Mainz, Mainz, Germany
| | - Heiko Braak
- Clinical Neuroanatomy Section, Department of Neurology, Center for Biomedical Research, University of Ulm
| |
Collapse
|
10
|
Tsukimura T, Tayama Y, Shiga T, Hirai K, Togawa T, Sakuraba H. Anti-drug antibody formation in Japanese Fabry patients following enzyme replacement therapy. Mol Genet Metab Rep 2020; 25:100650. [PMID: 33072516 PMCID: PMC7548986 DOI: 10.1016/j.ymgmr.2020.100650] [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: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 02/06/2023] Open
Abstract
Enzyme replacement therapy (ERT) for Fabry disease (deficiency of α-galactosidase A, α-Gal) with recombinant α-Gals (agalsidase alfa and agalsidase beta) is widely available and improves some of the clinical manifestations and biochemical findings. However, recent reports suggest that recurrent administration of recombinant enzymes often induces the formation of anti-drug antibodies, which may have a negative impact on the outcome of the therapy. We examined the formation of anti-drug antibodies using blood samples from 97 Japanese Fabry patients following ERT and tried to characterize them by means of enzyme-linked immunosorbent assay (ELISA), serum-mediated α-Gal inhibition, and immunochromatographic (IC) assay, followed by GLA gene analysis and measurement of plasma globotriaosylsphingosine (lyso-Gb3). ELISA revealed that 20/35 (57%) classic Fabry males were antibody (Immunoglobulin G, IgG) -positive (Ab+) at 6 months after the initiation of ERT, although only two of the seventeen (12%) later-onset Fabry males and none of the 45 Fabry females were. The Ab+ state was maintained at least until 24 months after the initiation of ERT in most of the cases, the exceptions being two patients who acquired immune tolerance during ERT. As many Ab+ patients have nonsense mutations, attention should be paid to the formation of anti-drug antibodies in Fabry patients harboring such gene mutations, who hardly produce α-Gal protein. Serum-mediated α-Gal inhibition was seen in most of the Ab+ patients and the antibodies affected the reduction of the plasma lyso-Gb3 level following ERT, suggesting that the antibodies inhibit the enzyme activity. There was a correlation between the results of the IC test and those of the ELISA. As the former is easy and rapid, it should be useful as a bed-side test. The anti-drug antibodies formed in Fabry patients during ERT were characterized. Serum-mediated α-Gal inhibition was seen in most of the antibody-positive patients. The immunochromatographic test is easy, rapid, and useful as a bed-side test.
Collapse
Affiliation(s)
- Takahiro Tsukimura
- Department of Functional Bioanalysis, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Yuya Tayama
- Department of Functional Bioanalysis, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Tomoko Shiga
- Department of Clinical Genetics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Kanako Hirai
- Department of Clinical Genetics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Tadayasu Togawa
- Department of Functional Bioanalysis, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Hitoshi Sakuraba
- Department of Clinical Genetics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| |
Collapse
|
11
|
Minami M, Mizuma E, Nakahara M, Oda Y, Yoshimine H, Tokunaga K, Mitsuke A, Yamada Y, Enokida H, Masutani K, Goto N, Ido A. A case of latent heterozygous Fabry disease in a female living kidney donor candidate. CEN Case Rep 2021; 10:30-4. [PMID: 32712909 DOI: 10.1007/s13730-020-00510-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 07/07/2020] [Indexed: 01/25/2023] Open
Abstract
A 52-year-old woman had been found to have hematuria at her annual checkup 5 years in a row. She hoped to donate her kidney to her husband, so we performed a percutaneous kidney biopsy at our department. It was difficult for us to detect apparent abnormalities under a light microscopic examination, and she was determined to meet the eligibility criteria for living kidney transplantation. However, the sample for electron microscopy was not evaluated before kidney donation. She subsequently underwent living kidney transplantation as a donor. A 1-h biopsy revealed swelling and obvious vacuolation of the glomerular podocytes, which were characteristic of Fabry disease. Her medical history and examinations were reviewed. No findings or episodes were observed. Pre-donation electronmicroscopy revealed numerous zebra bodies in the podocytes. A definite diagnosis of heterozygous Fabry disease was made based on the GLA gene mutation despite the normal range of leukocyte α-Gal A activity. Based on the pathological deposition of GL-3, chaperone therapy was initiated to suppress the progression of organ damage. In this case, we could not confirm a diagnosis of Fabry disease despite performing a renal biopsy prior to kidney donation. Kidney donor candidates may sometimes have factors that cannot be assumed based on medical or family history. Thus, it is important to perform a renal biopsy before kidney donation when necessary, and to always conduct a detailed evaluation including electron microscopy.
Collapse
|
12
|
Hewavitharana H, Jasinge E, Abeysekera H, Wanigasinghe J. Cornea Verticillata in classical Fabry disease, first from Sri Lanka: a case report. BMC Pediatr 2020; 20:338. [PMID: 32641113 PMCID: PMC7341576 DOI: 10.1186/s12887-020-02237-z] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/02/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Fabry disease is a rare inborn error of metabolism with profound clinical consequences if untreated. It is caused by the deficiency of α galactosidase A enzyme and is the only lysosomal storage disorder with an X linked inheritance. Confirmation requires genetic analysis of Galactosidase Alpha (GLA) Gene, which is often a challenge in resource-poor settings. Despite these technological limitations, specific clinical features in this condition can establish the diagnosis. CASE PRESENTATION We report on a 13-year old male who presented with an afebrile convulsion with a background history of chronic burning sensation of hands and feet and anhidrosis for 2 years duration with a similar history of episodic acroparesthesia in the other male sibling. The early clinical diagnosis was based on the history and detection of Cornea Verticillata on eye examination. Biochemical confirmation was established with detection of low α galactosidase A enzyme levels and a missense mutation of the Galactosidase Alpha (GLA) Gene (c.136C > T) established the genetic confirmation. CONCLUSION This is the first case of Fabry disease reported in Sri Lanka. Awareness of specific clinical features aided clinical diagnosis long before access to genetic confirmation was available.
Collapse
Affiliation(s)
- Hasani Hewavitharana
- Professorial Paediatric Unit, Lady Ridgeway Hospital for Children, Colombo 08, Sri Lanka
| | - Eresha Jasinge
- Department of Chemical Pathology, Lady Ridgeway Hospital for Children, Colombo 08, Sri Lanka
| | - Hiranya Abeysekera
- Department of Paediatric Ophthalmology, Lady Ridgeway Hospital for Children, Colombo 08, Sri Lanka
| | - Jithangi Wanigasinghe
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo 8, Sri Lanka
| |
Collapse
|
13
|
Nakamura K, Kawashima S, Tozawa H, Yamaoka M, Yamamoto T, Tanaka N, Yamamoto R, Okuyama T, Eto Y. Pharmacokinetics and pharmacodynamics of JR-051, a biosimilar of agalsidase beta, in healthy adults and patients with Fabry disease: Phase I and II/III clinical studies. Mol Genet Metab 2020; 130:215-224. [PMID: 32389574 DOI: 10.1016/j.ymgme.2020.04.003] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/27/2020] [Accepted: 04/27/2020] [Indexed: 12/01/2022]
Abstract
Fabry disease is a rare X-linked lysosomal disease, in which mutations in the gene encoding α-galactosidase A result in progressive cellular accumulation of globotriaosylceramide (GL-3) in various organs including the skin, kidney, and heart, often leading to life-threatening conditions. Enzyme replacement therapy is currently the standard therapy for the disease, to which two α-galactosidase A formulations have been approved: agalsidase α (Replagal®, Shire) and agalsidase β (Fabrazyme®, Sanofi). We have recently developed a biosimilar of agalsidase β, JR-051, and investigated its pharmacokinetics and pharmacodynamics to assess its bioequivalence to agalsidase β. In a randomized phase I study, healthy adult male volunteers were treated with JR-051 or agalsidase β and the pharmacokinetics of the drugs were compared. The ratio of geometric means (90% confidence interval [CI]) of the AUC0-24 and Cmax for JR-051 over agalsidase β were 0.91 (0.8294, 1.0082) and 0.90 (0.7992, 1.0125), respectively. In a 52-week, single-arm, phase II/III study, patients with Fabry disease switched therapy from agalsidase β to JR-051 to evaluate its pharmacodynamics. The mean (95% CI) plasma GL-3 concentrations at weeks 26 and 52 relative to pre-JR-051 administration were 1.03 (0.91, 1.15) and 0.96 (0.86, 1.06), respectively, which were within the pre-determined bioequivalence acceptance range (0.70, 1.43). The mean (95% CI) plasma globotriaosylsphingosine (lyso-GL-3) concentrations at weeks 26 and 52 relative to pre-JR-051 administration were 1.07 (0.92, 1.23) and 1.13 (1.03, 1.22), respectively. Estimated glomerular filtration rate and left ventricular mass index, as renal and cardiac function indicators, showed no notable changes from baseline throughout the study period, and no new safety concerns were identified. In conclusion, these studies demonstrated bioequivalence of JR-051 to agalsidase β in terms of its pharmacokinetics and pharmacodynamics. JR-051 offers a potential new treatment option for patients with Fabry disease.
Collapse
Affiliation(s)
- Kimitoshi Nakamura
- Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, Japan.
| | - Satoshi Kawashima
- Development Division, JCR Pharmaceuticals, 2-4 Kasuga-cho, Ashiya, Japan
| | - Hirotaka Tozawa
- Development Division, JCR Pharmaceuticals, 2-4 Kasuga-cho, Ashiya, Japan
| | - Mariko Yamaoka
- Development Division, JCR Pharmaceuticals, 2-4 Kasuga-cho, Ashiya, Japan
| | | | - Noboru Tanaka
- Research Division, JCR Pharmaceuticals, 2-2-9 Murotani, Nishi-ku, Kobe, Japan
| | - Ryuji Yamamoto
- Research Division, JCR Pharmaceuticals, 2-2-9 Murotani, Nishi-ku, Kobe, Japan
| | | | - Yoshikatsu Eto
- Advanced Clinical Research Centre & Asian Lysosome Storage Disorder Centre, Institute of Neurological Disorders, Japan
| |
Collapse
|
14
|
Sakuraba H, Tsukimura T, Togawa T, Tanaka T, Ohtsuka T, Sato A, Shiga T, Saito S, Ohno K. Fabry disease in a Japanese population-molecular and biochemical characteristics. Mol Genet Metab Rep 2018; 17:73-79. [PMID: 30386727 PMCID: PMC6205336 DOI: 10.1016/j.ymgmr.2018.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/12/2018] [Accepted: 10/12/2018] [Indexed: 12/27/2022] Open
Abstract
We had experienced 117 Japanese Fabry patients (72 males and 45 females) from 1977 to 2006, and then we generated an improved Fabry analysis system in 2007 and have found 196 ones (95 males and 101 females) since then. In this study, we summarized the data of the patients and tried to elucidate the molecular and biochemical characteristics of Japanese Fabry patients. Gene analysis revealed various GLA mutations, including missense mutations (56.5%, 48 types); nonsense mutations (15.9%, 13 types); deletions (12.6%, 13 types); splicing defects (10.1%, 6 types); insertions (1.0%, 2 types), and insertions/deletions (0.5%, 1 type), in the patients that were tested. Amino acid substitutions resulting from the missense mutations found in the classic form patients tended to be localized in the core of the GLA protein, and those in the later-onset ones in the peripheral region. The most commonly identified pathogenic mutations are c.888G > A (p.M296I), c.936 + 919G > A, c.679C > T (p.R227X), c.335G > A (p.R112H), c.334C > T (p.R112C), and c.902G > A (p.R301Q). Among them, c.888G > A (p.M296I) is unique to Japanese Fabry patients. On the other hand, c.936 + 919G > A is a variant that has been frequently detected in Taiwan Chinese Fabry patients, and c.335G > A (p.R112H) in various countries. These are found in later-onset patients, and c.679C > T (p.R227X) and c.334C > T (p.R112C) classic ones. c.902G > A (p.R301Q) is found in both classic and later-onset form patients. A possible functional polymorphism, c.196G > C (p.E66Q), was identified in 0.4% of the subjects who underwent high-risk screening. The biochemical findings including leukocyte α-galactosidase A activity, plasma globotriaosylsphingosine level and urinary globotriaosylceramide in the individual phenotypic groups well reflected the phenotypic differences in this disease. The results will be useful for understanding the basis of Fabry disease in Japan. The characteristics of Japanese Fabry patients were elucidated. p.M296I unique to Japanese Fabry patients was commonly identified. The biochemical findings well reflected the phenotypic differences.
Collapse
Affiliation(s)
- Hitoshi Sakuraba
- Department of Clinical Genetics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Takahiro Tsukimura
- Department of Functional Bioanalysis, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Tadayasu Togawa
- Department of Functional Bioanalysis, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Toshie Tanaka
- Department of Clinical Genetics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Tomoko Ohtsuka
- Department of Clinical Genetics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Atsuko Sato
- Department of Clinical Genetics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Tomoko Shiga
- Department of Clinical Genetics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Seiji Saito
- Department of Medical Management and Informatics, Hokkaido Information University, 59-2 Nishi-nopporo, Ebetsu, Hokkaido 069-8585, Japan
| | - Kazuki Ohno
- Catalyst Inc., 1-5-6 Kudan-minami, Chiyoda-ku, Tokyo 102-0074, Japan
| |
Collapse
|
15
|
Morimoto H, Ito Y, Yoden E, Horie M, Tanaka N, Komurasaki Y, Yamamoto R, Mihara K, Minami K, Hirato T. Non-clinical evaluation of JR-051 as a biosimilar to agalsidase beta for the treatment of Fabry disease. Mol Genet Metab 2018; 125:153-160. [PMID: 30054149 DOI: 10.1016/j.ymgme.2018.07.009] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 11/28/2022]
Abstract
Fabry disease (FD) is an X-linked lysosomal storage disease. It is caused by deficiency of the enzyme α-galactosidase A (α-Gal A), which leads to excessive deposition of neutral glycosphingolipids, especially globotriaosylceramide (GL-3), in cells throughout the body. Progressive accumulation of GL-3 causes life-threatening complications in several tissues and organs, including the vasculature, heart, and kidney. Currently available enzyme replacement therapy for FD employs recombinant α-Gal A in two formulations, namely agalsidase alfa and agalsidase beta. Here, we evaluated JR-051 as a biosimilar to agalsidase beta in a non-clinical study. JR-051 was shown to have identical primary and similar higher-order structures to agalsidase beta. Mannose-6-phosphate content was higher in JR-051 than in agalsidase beta, which probably accounts for a slightly better uptake into fibroblasts in vitro. In spite of these differences in in vitro biological features, pharmacokinetic profiles of the two compounds in mice, rats, and monkeys were similar. The ability to reduce GL-3 accumulation in the kidney, heart, skin, liver, spleen, and plasma of Gla-knockout mice, a model of FD, was not different between JR-051 and agalsidase beta. Furthermore, we identified no safety concerns regarding JR-051 in a 13-week evaluation using cynomolgus monkeys. These findings indicate that JR-051 is similar to agalsidase beta in terms of physicochemical and biological properties.
Collapse
Affiliation(s)
- Hideto Morimoto
- Research Division, JCR Pharmaceuticals, 2-2-9 Murotani, Nishi-ku, Kobe 651-2241, Japan
| | - Yae Ito
- Research Division, JCR Pharmaceuticals, 2-2-9 Murotani, Nishi-ku, Kobe 651-2241, Japan
| | - Eiji Yoden
- Research Division, JCR Pharmaceuticals, 2-2-9 Murotani, Nishi-ku, Kobe 651-2241, Japan
| | - Masato Horie
- Research Division, JCR Pharmaceuticals, 2-2-9 Murotani, Nishi-ku, Kobe 651-2241, Japan
| | - Noboru Tanaka
- Research Division, JCR Pharmaceuticals, 2-2-9 Murotani, Nishi-ku, Kobe 651-2241, Japan
| | - Yoshikazu Komurasaki
- Research Division, JCR Pharmaceuticals, 2-2-9 Murotani, Nishi-ku, Kobe 651-2241, Japan
| | - Ryuji Yamamoto
- Research Division, JCR Pharmaceuticals, 2-2-9 Murotani, Nishi-ku, Kobe 651-2241, Japan
| | - Kazutoshi Mihara
- Research Division, JCR Pharmaceuticals, 2-2-9 Murotani, Nishi-ku, Kobe 651-2241, Japan
| | - Kohtaro Minami
- Research Division, JCR Pharmaceuticals, 2-2-9 Murotani, Nishi-ku, Kobe 651-2241, Japan.
| | - Tohru Hirato
- Research Division, JCR Pharmaceuticals, 2-2-9 Murotani, Nishi-ku, Kobe 651-2241, Japan.
| |
Collapse
|
16
|
Okada J, Hossain MA, Wu C, Miyajima T, Yanagisawa H, Akiyama K, Eto Y. Ten-year-long enzyme replacement therapy shows a poor effect in alleviating giant leg ulcers in a male with Fabry disease. Mol Genet Metab Rep 2017; 14:68-72. [PMID: 29326878 PMCID: PMC5758919 DOI: 10.1016/j.ymgmr.2017.12.004] [Citation(s) in RCA: 2] [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: 09/19/2017] [Revised: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 11/25/2022] Open
Abstract
Fabry disease is an X-linked lysosomal storage disorder caused by a deficiency of α-galactosidase A (α-gal A), leading to the progressive accumulation of glycosphingolipids. Classical hemizygous males usually present symptoms, including pain and paresthesia in the extremities, angiokeratoma, hypo- or anhidrosis, abdominal pain, cornea verticillata, early stroke, tinnitus, and/or hearing loss, during early childhood or adolescence. Moreover, proteinuria, renal impairment, and cardiac hypertrophy can appear with age. Enzyme replacement is the most common therapy for Fabry disease at present which has been approved in Japan since 2004. We report a case involving a 27-year-old male with extreme terminal pain, anhidrosis, abdominal pain, tinnitus, hearing impairment, cornea verticillata, and recurrent huge ulcers in the lower extremities. At the age of 16 years, he was diagnosed with Fabry disease with a positive family history and very low α-gal A activity. He then received enzyme replacement therapy (ERT) with recombinant human agalsidase beta at 1 mg/kg every 2 weeks for 10 years. Throughout the course of ERT, his leg ulcers recurred, and massive excretion of urinary globotriaosylceramide and plasma globotriaosylsphingosine was observed. Electron microscopy of the venous tissue in the regions of the ulcer showed massive typical zebra bodies in the vascular wall smooth muscle cells. A classical hemizygous male with Fabry disease presented with massive intractable leg ulcer. 10 years' enzyme replacement therapy showed huge excretion of urinary Gb3 and plasma lyso-Gb3. Excessive zebra bodies in vascular wall smooth muscle cells caused venous reflux and varices on saphenous veins.
Collapse
Affiliation(s)
- Jun Okada
- Asakadai Central General Hospital, Asaka City, Japan
| | - Mohammad Arif Hossain
- Advanced Clinical Research Center, Institute of Neurological Disorders, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan.,Department of Gene Therapy, Institute for DNA Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Chen Wu
- Advanced Clinical Research Center, Institute of Neurological Disorders, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Takashi Miyajima
- Advanced Clinical Research Center, Institute of Neurological Disorders, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Hiroko Yanagisawa
- Advanced Clinical Research Center, Institute of Neurological Disorders, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Keiko Akiyama
- Advanced Clinical Research Center, Institute of Neurological Disorders, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Yoshikatsu Eto
- Advanced Clinical Research Center, Institute of Neurological Disorders, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan.,Department of Gene Therapy, Institute for DNA Medicine, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
17
|
Nowak A, Mechtler T, Kasper DC, Desnick RJ. Correlation of Lyso-Gb3 levels in dried blood spots and sera from patients with classic and Later-Onset Fabry disease. Mol Genet Metab 2017; 121:320-324. [PMID: 28663131 DOI: 10.1016/j.ymgme.2017.06.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [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: 04/27/2017] [Revised: 06/16/2017] [Accepted: 06/16/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Fabry disease (FD), an X-linked lysosomal storage disorder, results from the deficient activity of α-galactosidase A (α-Gal A) and the accumulation of its substrates, globotriaosylceramide (Gb3) and its deacylated derivative, globotriaosyl-sphingosine (Lyso-Gb3). Here, we compared the levels of Lyso-Gb3 in dried blood spots (DBS) and sera in affected males and heterozygotes with the "Classic" and "Later-Onset" phenotypes. METHODS The Lyso-Gb3 concentrations in DBS and sera from 56 FD patients were determined by highly sensitive electrospray ionization liquid chromatography tandem mass spectrometry. RESULTS The serum Lyso-Gb3 levels in 18 and 5 affected males with the Classic and Later-Onset phenotypes, were 61±38 and 14±12ng/mL, respectively. Lyso-Gb3 levels in 30 females from Classic families and three females from Later-Onset families were 10±5.4 and 2.4±1.0ng/mL, respectively. The linear regression model with serum Lyso-Gb3 as the dependent variable and DBS Lyso-Gb3 an independent variable was described by the function y=-1.83+1.68∗x and showed a high coefficient of determination, R2=0.976. The overall correlation between the Lyso-Gb3 levels in DBS and sera was high (R=0.99; p<0.001). CONCLUSION DBS provides a convenient, sensitive, and reproducible source to measure Lyso-Gb3 levels for diagnosis, initial phenotypic assignment, and therapeutic monitoring in patients with Fabry disease.
Collapse
Affiliation(s)
- Albina Nowak
- Department of Internal Medicine, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland.
| | - Thomas Mechtler
- ARCHIMED Life Science, Leberstrasse 20, 1110 Vienna, Austria.
| | - David C Kasper
- ARCHIMED Life Science, Leberstrasse 20, 1110 Vienna, Austria.
| | - Robert J Desnick
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA.
| |
Collapse
|
18
|
Yuasa T, Takenaka T, Higuchi K, Uchiyama N, Horizoe Y, Cyaen H, Mizukami N, Takasaki K, Kisanuki A, Miyata M, Ohishi M. Fabry disease. J Echocardiogr 2017; 15:151-157. [PMID: 28674962 DOI: 10.1007/s12574-017-0340-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 05/13/2017] [Accepted: 06/09/2017] [Indexed: 02/02/2023]
Abstract
Fabry disease resulting from a deficiency of α-galactosidase A leads to the accumulation of globotriaosylceramide in various organs. Because the disease is an X-linked recessive disorder, males tend to develop more symptoms and more severe symptoms than females. There are also some variants of Fabry disease, and cardiac variant (cardiac Fabry disease) has the dysfunctions only in heart. Cardiac manifestations in Fabry disease are initially symmetrical and concentric left ventricular hypertrophy, and later progressive cardiac dysfunction with localized thinning of the basal posterior wall. In recent years, enzyme replacement therapy has been performed as a treatment for Fabry disease, and the initiation of this therapy is expected before the cardiac fibrosis develops. Therefore, early diagnosis of Fabry disease is essential, and echocardiography is an indispensable tool for clinical practice of this disease. Then, it is necessary to remember this disease as a differential diagnosis when encountering unexplained left ventricular hypertrophy.
Collapse
Affiliation(s)
- Toshinori Yuasa
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima, Japan.
| | - Toshihiro Takenaka
- Department of Internal Medicine, Tarumizu Chuo Hospital, Tarumizu, Japan
| | - Koji Higuchi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima, Japan
| | - Nami Uchiyama
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima, Japan
| | - Yoshihisa Horizoe
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima, Japan
| | - Hideto Cyaen
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima, Japan
| | - Naoko Mizukami
- Clinical Laboratory, Kagosima University Hospital, Kagoshima, Japan
| | - Kunitsugu Takasaki
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima, Japan
| | - Akira Kisanuki
- Department of Health Science, Kagoshima University Faculty of Medicine, Kagoshima, Japan
| | - Masaaki Miyata
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima, Japan
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima, Japan
| |
Collapse
|
19
|
Hossain MA, Yanagisawa H, Miyajima T, Wu C, Takamura A, Akiyama K, Itagaki R, Eto K, Iwamoto T, Yokoi T, Kurosawa K, Numabe H, Eto Y. The severe clinical phenotype for a heterozygous Fabry female patient correlates to the methylation of non-mutated allele associated with chromosome 10q26 deletion syndrome. Mol Genet Metab 2017; 120:173-179. [PMID: 28087245 DOI: 10.1016/j.ymgme.2017.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 01/06/2017] [Accepted: 01/06/2017] [Indexed: 11/18/2022]
Abstract
Heterozygous Fabry females usually have an attenuated form of Fabry disease, causing them to be symptomatic; however, in rare cases, they can present with a severe phenotype. In this study, we report on a 37-year-old woman with acroparesthesia, a dysmorphic face, left ventricular hypertrophy, and intellectual disability. Her father had Fabry disease and died due to chronic renal and congestive cardiac failure. Her paternal uncle had chronic renal failure and intellectual disability, and her paternal aunt was affected with congestive cardiac failure. The patient has two sisters with no significant medical illness. However, her nephew has acroparesthesia, anhidrosis, and school phobia, and her niece shows mild phenotypes. The patient's enzyme analysis showed very low α-galactosidase A (α-gal A) activity in dried blood spot (DBS), lymphocytes, and skin fibroblasts with massive excretion of Gb3 and Gb2 in urine and lyso-Gb3 in DBS and plasma. Electron microscopic examination showed a large accumulation of sphingolipids in vascular endothelial cells and keratinocytes. Chromosomal analysis and comparative genomic hybridization microarray showed 10q26 terminal deletion. Molecular data showed a novel heterozygous stop codon mutation in exon 1 of the GLA gene in her sisters and niece, and a hemizygous state in her nephew. When we checked the methylation status, we found her non-mutated allele in the GLA gene was methylated. However, the non-mutated alleles of her sisters were non-methylated, and those of her niece were partially methylated. The chromosomal and methylation study may speculate the severity of her clinical phenotypes.
Collapse
Affiliation(s)
- Mohammad Arif Hossain
- Advanced Clinical Research Center, Institute of Neurological Disorders, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan.
| | - Hiroko Yanagisawa
- Advanced Clinical Research Center, Institute of Neurological Disorders, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Takashi Miyajima
- Advanced Clinical Research Center, Institute of Neurological Disorders, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Chen Wu
- Advanced Clinical Research Center, Institute of Neurological Disorders, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Ayumi Takamura
- Department of Biological Regulation School of Health Science, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Keiko Akiyama
- Advanced Clinical Research Center, Institute of Neurological Disorders, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Rina Itagaki
- Advanced Clinical Research Center, Institute of Neurological Disorders, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Kaoru Eto
- Department of Pediatrics, Tokyo Women's Medical University, Tokyo, Japan
| | - Takeo Iwamoto
- Advanced Clinical Research Center, Institute of Neurological Disorders, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan; Core Research Facilities for Basic Science, The Jikei University School of Medicine, Tokyo, Japan
| | - Takayuki Yokoi
- Division of Medical Genetics, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | - Kenji Kurosawa
- Division of Medical Genetics, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | - Hironao Numabe
- Department of Genetic Counselling, Natural Science Division, Faculty of Core Research, Ochanomizu University, Tokyo, Japan
| | - Yoshikatsu Eto
- Advanced Clinical Research Center, Institute of Neurological Disorders, Shin-Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan; Department of Gene Therapy, Institute for DNA Medicine, The Jikei University School of Medicine, Tokyo, Japan.
| |
Collapse
|
20
|
Kodama T, Tsukimura T, Kawashima I, Sato A, Sakuraba H, Togawa T. Differences in cleavage of globotriaosylceramide and its derivatives accumulated in organs of young Fabry mice following enzyme replacement therapy. Mol Genet Metab 2017; 120:116-120. [PMID: 27756537 DOI: 10.1016/j.ymgme.2016.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 07/24/2016] [Revised: 10/10/2016] [Accepted: 10/10/2016] [Indexed: 11/23/2022]
Abstract
In Fabry disease, large amounts of globotriaosylceramide (Gb3) and related glycosphingolipids accumulate in organs due to a deficiency of α-galactosidase A (GLA) activity. Enzyme replacement therapy (ERT) with recombinant GLA is now available, and it has been reported that ERT is beneficial for patients with Fabry disease, especially those who start treatment at an early stage of the disease. However, it seems that the efficacy of ERT differs with each organ, and Gb3 accumulated in the kidneys shows resistance to ERT when it is started at a late stage. In this study, we examined the differences in cleavage of Gb3 isoforms, and lyso-Gb3 and its analogues in the kidneys, liver, and heart in young Fabry mice subjected to ERT. The results revealed that recurrent administration of recombinant GLA had prominent effects in terms of degradation of Gb3 and its derivatives accumulated in the organs. However, particular Gb3 isoforms, i.e., Gb3 (C20:0) and Gb3 (C24OH), accumulated in the kidneys largely escaped from degradation. Such Gb3 isoforms may gradually accumulate in the kidneys from a young age, which results in a reduction in the efficacy of ERT for Fabry disease.
Collapse
Affiliation(s)
- Takashi Kodama
- Department of Functional Bioanalysis, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Takahiro Tsukimura
- Department of Functional Bioanalysis, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Ikuo Kawashima
- Laboratory of Biomembrane, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 113-0021, Japan
| | - Atsuko Sato
- Department of Clinical Genetics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Hitoshi Sakuraba
- Department of Clinical Genetics, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Tadayasu Togawa
- Department of Functional Bioanalysis, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588, Japan.
| |
Collapse
|
21
|
Ferreira S, Auray-Blais C, Boutin M, Lavoie P, Nunes JP, Martins E, Garman S, Oliveira JP. Variations in the GLA gene correlate with globotriaosylceramide and globotriaosylsphingosine analog levels in urine and plasma. Clin Chim Acta 2015; 447:96-104. [PMID: 26070511 PMCID: PMC4793778 DOI: 10.1016/j.cca.2015.06.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/03/2015] [Indexed: 12/14/2022]
Abstract
Recent data have shown that lyso-Gb3, the deacylated derivative of globotriaosylceramide (Gb3), is possibly involved in the pathogenesis of Fabry disease (FD) and might be a clinically useful biomarker of its metabolic load. To test this hypothesis, we assayed Gb3 and lyso-Gb3 and related analogs in plasma and/or urine samples of 12 clinically well-characterized subjects carrying several different GLA variant alleles associated with a wide range of residual α-galactosidase A activities. Urinary Gb3 was measured by HPLC-MS/MS; plasma and urinary lyso-Gb3 and related analogs were measured by UPLC-MS/MS. Individual profiles of Gb3 and lyso-Gb3 and related analogs closely correlated with the phenotypic data for each subject, discerning the classical FD patient from the two patients carrying cardiac variants as well as those from all the others without FD. The lyso-Gb3 analog at m/z 836 was found at increased levels only in patients manifesting clinically severe heart disease, irrespective of the pathogenicity of the GLA variant they carried. This finding suggests that this lyso-Gb3 analog might be an earlier biomarker of progressive heart disease, non-specific of the FD cardiomyopathy. The possibility that urinary Gb3 is a specific marker of kidney involvement in FD deserves further study.
Collapse
Affiliation(s)
- Susana Ferreira
- Department of Genetics, Faculty of Medicine, University of Porto, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - Christiane Auray-Blais
- Division of Medical Genetics, Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, Quebec J1H 5N4, Canada.
| | - Michel Boutin
- Division of Medical Genetics, Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, Quebec J1H 5N4, Canada.
| | - Pamela Lavoie
- Division of Medical Genetics, Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, Quebec J1H 5N4, Canada.
| | - José Pedro Nunes
- Service of Cardiology, São João Hospital Centre, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - Elisabete Martins
- Service of Cardiology, São João Hospital Centre, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - Scott Garman
- Department of Biochemistry and Molecular Biology, University of Massachusetts Amherst, Amherst, MA 01003, USA.
| | - João Paulo Oliveira
- Department of Genetics, Faculty of Medicine, University of Porto, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal; Medical Genetics Outpatient Clinic, São João Hospital Centre, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal.
| |
Collapse
|
22
|
Sakuraba H, Tsukimura T, Tanaka T, Togawa T, Takahashi N, Mikami D, Wakai S, Akai Y. Clinical and biochemical investigation of male patients exhibiting membranous cytoplasmic bodies in biopsied kidney tissues; a pitfall in diagnosis of Fabry disease. J Nephropathol 2015; 4:91-6. [PMID: 26312237 PMCID: PMC4544560 DOI: 10.12860/jnp.2015.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 01/28/2015] [Accepted: 02/22/2015] [Indexed: 11/20/2022] Open
Abstract
Background: The existence of membranous cytoplasmic bodies in biopsied kidney tissues is one of the important findings when considering Fabry disease as the first choice diagnosis. However, there are possible acquired lysosomal diseases associated with pharmacological toxicity, although less attention has been paid to them.
Case Presentation: We experienced 3 male patients presenting with proteinuria and specific pathological changes strongly suggesting Fabry disease. We sought detailed clinical and biochemical information to avoid a wrong diagnosis. The patients were examined clinically and pathologically, and plasma α-galactosidase A (GLA) activity and the globotriaosylsphingosine (lyso-Gb3) concentrations were measured. Electron microscopic examination revealed numerous membranous inclusion bodies in podocytes, and biochemical analysis revealed normal GLA activity and a normal lyso-Gb3 level in plasma, showing that they did not have Fabry disease. They suffered from hyperlipidemia, myeloma, or lupus nephritis. They had received pitavastatin calcium, clarithromycin, loxoprofen and/or prednisolone, and there was no medication history of cationic amphiphilic drugs.
Conclusions: In this case series, the etiology of the inclusions was not clarified. However, these cases indicate that careful attention should be paid on diagnosis of patients exhibiting inclusion bodies in kidney cells, and it is important to confirm their past and present illnesses, and medication history as well as to measure the GLA activity and lyso-Gb3 level.
Collapse
Affiliation(s)
- Hitoshi Sakuraba
- Department of Clinical Genetics, Meiji Pharmaceutical University, Kiyose, Tokyo, Japan
| | - Takahiro Tsukimura
- Departmentof Functional Bioanalysis, Meiji Pharmaceutical University, Kiyose, Tokyo, Japan
| | - Toshie Tanaka
- Department of Clinical Genetics, Meiji Pharmaceutical University, Kiyose, Tokyo, Japan
| | - Tadayasu Togawa
- Departmentof Functional Bioanalysis, Meiji Pharmaceutical University, Kiyose, Tokyo, Japan
| | - Naoki Takahashi
- Division of Nephrology, Department of General Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Daisuke Mikami
- Division of Nephrology, Department of General Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Sachiko Wakai
- Division of Nephrology, Department of Internal Medicine, Ohkubo Hospital, Tokyo Metropolitan Health and Medical Treatment Corporation, Shinjuku, Tokyo, Japan
| | - Yasuhiro Akai
- The 1st Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan
| |
Collapse
|
23
|
Ferreira S, Ortiz A, Germain DP, Viana-Baptista M, Caldeira-Gomes A, Camprecios M, Fenollar-Cortés M, Gallegos-Villalobos Á, Garcia D, García-Robles JA, Egido J, Gutiérrez-Rivas E, Herrero JA, Mas S, Oancea R, Péres P, Salazar-Martín LM, Solera-Garcia J, Alves H, Garman SC, Oliveira JP. The alpha-galactosidase A p.Arg118Cys variant does not cause a Fabry disease phenotype: data from individual patients and family studies. Mol Genet Metab 2015; 114:248-58. [PMID: 25468652 PMCID: PMC4423738 DOI: 10.1016/j.ymgme.2014.11.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [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: 09/02/2014] [Revised: 10/31/2014] [Accepted: 11/01/2014] [Indexed: 10/24/2022]
Abstract
Lysosomal α-galactosidase A (α-Gal) is the enzyme deficient in Fabry disease (FD), an X-linked glycosphingolipidosis caused by pathogenic mutations affecting the GLA gene. The early-onset, multi-systemic FD classical phenotype is associated with absent or severe enzyme deficiency, as measured by in vitro assays, but patients with higher levels of residual α-Gal activity may have later-onset, more organ-restricted clinical presentations. A change in the codon 118 of the wild-type α-Gal sequence, replacing basic arginine by a potentially sulfhydryl-binding cysteine residue - GLA p.(Arg118Cys) -, has been recurrently described in large FD screening studies of high-risk patients. Although the Cys118 allele is associated with high residual α-Gal activity in vitro, it has been classified as a pathogenic mutation, mainly on the basis of theoretical arguments about the chemistry of the cysteine residue. However its pathogenicity has never been convincingly demonstrated by pathology criteria. We reviewed the clinical, biochemical and histopathology data obtained from 22 individuals of Portuguese and Spanish ancestry carrying the Cys118 allele, including 3 homozygous females. Cases were identified either on the differential diagnosis of possible FD manifestations and on case-finding studies (n=11; 4 males), or on unbiased cascade screening of probands' close relatives (n=11; 3 males). Overall, those data strongly suggest that the GLA p.(Arg118Cys) variant does not segregate with FD clinical phenotypes in a Mendelian fashion, but might be a modulator of the multifactorial risk of cerebrovascular disease. The Cys118 allelic frequency in healthy Portuguese adults (n=696) has been estimated as 0.001, therefore not qualifying for "rare" condition.
Collapse
Affiliation(s)
- Susana Ferreira
- Departamento de Genética, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal.
| | - Alberto Ortiz
- Servicio de Nefrología, Instituto de Investigación Sanitaria IIS-Fundación Jiménez Diaz, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Dominique P Germain
- University of Versailles, UFR des sciences de la santé Simone Veil, Division of Medical Genetics, 78180 Montigny, France.
| | - Miguel Viana-Baptista
- Serviço de Neurologia, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Centro de Estudo de Doenças Crónicas (CEDOC), Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal.
| | | | - Marta Camprecios
- Servicio de Cardiología, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Maria Fenollar-Cortés
- Laboratorio de Genética Clínica, Servicio de Análisis Clínicos, Hospital Clínico Universitario San Carlos, Madrid, Spain.
| | - Ángel Gallegos-Villalobos
- Servicio de Nefrología, Instituto de Investigación Sanitaria IIS-Fundación Jiménez Diaz, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Diego Garcia
- Health In Code, Hospital Marítimo de Oza, A Coruña, Spain
| | | | - Jesús Egido
- Servicio de Nefrología, Instituto de Investigación Sanitaria IIS-Fundación Jiménez Diaz, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
| | | | - José Antonio Herrero
- Servicio de Nefrología, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Sebastián Mas
- Servicio de Nefrología, Instituto de Investigación Sanitaria IIS-Fundación Jiménez Diaz, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Raluca Oancea
- Laboratorio de Genética Clínica, Servicio de Análisis Clínicos, Instituto de Investigación Sanitaria, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Paloma Péres
- Servicio de Cardiología, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Jesús Solera-Garcia
- Instituto de Genética Médica y Molecular, Instituto de Investigación Sanitaria del Hospital Universitario La Paz, Madrid, Spain
| | - Helena Alves
- Centro de Histocompatibilidade do Norte, Porto, Portugal.
| | - Scott C Garman
- Department of Biochemistry and Molecular Biology, University of Massachusetts, Amherst, MA, USA.
| | - João Paulo Oliveira
- Departamento de Genética, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal; Serviço de Nefrologia, Centro Hospitalar de São João, 4200-319 Porto, Portugal; Consulta de Genética Médica, Centro Hospitalar de São João, 4200-319 Porto, Portugal.
| |
Collapse
|
24
|
Tsukimura T, Nakano S, Togawa T, Tanaka T, Saito S, Ohno K, Shibasaki F, Sakuraba H. Plasma mutant α-galactosidase A protein and globotriaosylsphingosine level in Fabry disease. Mol Genet Metab Rep 2014; 1:288-298. [PMID: 27896103 PMCID: PMC5121323 DOI: 10.1016/j.ymgmr.2014.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 07/02/2014] [Accepted: 07/02/2014] [Indexed: 11/16/2022] Open
Abstract
Fabry disease is an X-linked genetic disorder characterized by deficient activity of α-galactosidase A (GLA) and accumulation of glycolipids, and various GLA gene mutations lead to a wide range of clinical phenotypes from the classic form to the later-onset one. To investigate the biochemical heterogeneity and elucidate the basis of the disease using available clinical samples, we measured GLA activity, GLA protein and accumulated globotriaosylsphingosine (Lyso-Gb3), a biomarker of this disease, in plasma samples from Fabry patients. The analysis revealed that both the enzyme activity and the protein level were apparently decreased, and the enzyme activity was well correlated with the protein level in many Fabry patients. In these cases, a defect of biosynthesis or excessive degradation of mutant GLAs should be involved in the pathogenesis, and the residual protein level would determine the accumulation of Lyso-Gb3 and the severity of the disease. However, there are some exceptional cases, i.e., ones harboring p.C142Y, p.R112H and p.M296I, who exhibit a considerable amount of GLA protein. Especially, a subset of Fabry patients with p.R112H or p.M296I has been attracted interest because the patients exhibit almost normal plasma Lyso-Gb3 concentration. Structural analysis revealed that C142Y causes a structural change at the entrance of the active site. It will lead to a complete enzyme activity deficiency, resulting in a high level of plasma Lyso-Gb3 and the classic Fabry disease. On the other hand, it is thought that R112H causes a relatively large structural change on the molecular surface, and M296I a small one in a restricted region from the core to the surface, both the structural changes being far from the active site. These changes will cause not only partial degradation but also degeneration of the mutant GLA proteins, and the degenerated enzymes exhibiting small and residual activity remain and probably facilitate degradation of Lyso-Gb3 in plasma, leading to the later-onset phenotype. The results of this comprehensive analysis will be useful for elucidation of the basis of Fabry disease.
Collapse
Affiliation(s)
- Takahiro Tsukimura
- Department of Functional Bioanalysis, Meiji Pharmaceutical University, Tokyo, Japan
| | - Sachie Nakano
- Department of Molecular Medical Research, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan; Synthera Technologies, Co., Ltd., Tokyo, Japan
| | - Tadayasu Togawa
- Department of Functional Bioanalysis, Meiji Pharmaceutical University, Tokyo, Japan
| | - Toshie Tanaka
- Department of Clinical Genetics, Meiji Pharmaceutical University, Tokyo, Japan
| | - Seiji Saito
- Department of Medical Management and Informatics, Hokkaido Information University, Hokkaido, Japan
| | - Kazuki Ohno
- NPO for the Promotion of Research on Intellectual Property Tokyo, Tokyo, Japan
| | - Futoshi Shibasaki
- Department of Molecular Medical Research, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Hitoshi Sakuraba
- Department of Clinical Genetics, Meiji Pharmaceutical University, Tokyo, Japan
| |
Collapse
|
25
|
Trimarchi H, Karl A, Raña MS, Forrester M, Pomeranz V, Lombi F, Iotti A. Initially Nondiagnosed Fabry's Disease when Electron Microscopy Is Lacking: The Continuing Story of Focal and Segmental Glomerulosclerosis. Case Rep Nephrol Urol 2013; 3:51-7. [PMID: 24167512 PMCID: PMC3808792 DOI: 10.1159/000351516] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Focal and segmental glomerulosclerosis is classified as either primary or secondary. We present a patient with a past history of biopsy-proven focal and segmental glomerulosclerosis. Despite initial response to dual blockade and steroids, proteinuria raised when steroids were decreased. After the patient was restarted on steroids, proteinuria did not improve. Another biopsy confirmed the previous diagnosis but suggested Fabry's disease, later confirmed by electron microscopy, α-galactosidase A serum and leukocyte deficiency as well as genetic studies. Proteinuria decreased when agalsidase β was prescribed in parallel with steroid tapering, increased with steroid discontinuation and improved with meprednisone administration. This report highlights the relevance of electron microscopy in kidney biopsy. In glomerulosclerosis, despite specific treatment, secondary hemodynamic and immunologic pathways may contribute to the development of proteinuria and accelerate the renal disease progression due to the primary disease. We discuss possible pathophysiologic pathways involved in proteinuria in Fabry's disease according to the biopsy and the therapeutic response.
Collapse
Affiliation(s)
- H Trimarchi
- Nephrology Service, Hospital Británico, Buenos Aires, Argentina
| | | | | | | | | | | | | |
Collapse
|