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Nakamura K, Mukai S, Takezawa Y, Natori Y, Miyazaki A, Ide Y, Takebuchi M, Nanato K, Katoh M, Suzuki H, Sakyu A, Kojima T, Kise E, Hanafusa H, Kosho T, Kuwahara K, Sekijima Y. Clinical utility of urinary mulberry bodies/cells testing in the diagnosis of Fabry disease. Mol Genet Metab Rep 2023; 36:100983. [PMID: 37323223 PMCID: PMC10267638 DOI: 10.1016/j.ymgmr.2023.100983] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Variants in the galactosidase alpha (GLA) gene cause Fabry disease (FD), an X-linked lysosomal storage disorder caused by α-galactosidase A (α-GAL) deficiency. Recently, disease-modifying therapies have been developed, and simple diagnostic biomarkers for FD are required to initiate these therapies in the early stages of the disease. Detection of urinary mulberry bodies and cells (MBs/MCs) is beneficial for diagnosing FD. However, few studies have evaluated the diagnostic accuracy of urinary MBs/MCs in FD. Herein, we retrospectively evaluated the diagnostic ability of urinary MBs/MCs for FD. Methods We analyzed the medical records of 189 consecutive patients (125 males and 64 females) who underwent MBs/MCs testing. Out of these, two female patients had already been diagnosed with FD at the time of testing, and the remaining 187 patients were suspected of having FD and underwent both GLA gene sequencing and/or α-GalA enzymatic testing. Results Genetic testing did not confirm the diagnosis in 50 females (26.5%); hence, they were excluded from the evaluation. Two patients were previously diagnosed with FD, and sixteen were newly diagnosed. Among these 18 patients, 15, including two who had already developed HCM at diagnosis, remained undiagnosed until targeted genetic screening of at-risk family members of patients with FD was performed. The accuracy of urinary MBs/MCs testing exhibited a sensitivity of 0.944, specificity of 1, positive predictive value of 1, and negative predictive value of 0.992. Conclusions MBs/MCs testing is highly accurate in diagnosing FD and should be considered during the initial evaluation prior to genetic testing, particularly in female patients.
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Affiliation(s)
- Katsuya Nakamura
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
- Center for Medical Genetics, Shinshu University Hospital, Matsumoto, Japan
| | - Saki Mukai
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Yuka Takezawa
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Yuika Natori
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Akari Miyazaki
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Yuichiro Ide
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Mayu Takebuchi
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Kana Nanato
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Mizuki Katoh
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Harue Suzuki
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Akiko Sakyu
- Center for Medical Genetics, Shinshu University Hospital, Matsumoto, Japan
| | - Tomomi Kojima
- Center for Medical Genetics, Shinshu University Hospital, Matsumoto, Japan
| | - Emiko Kise
- Center for Medical Genetics, Shinshu University Hospital, Matsumoto, Japan
| | - Hiroaki Hanafusa
- Center for Medical Genetics, Shinshu University Hospital, Matsumoto, Japan
| | - Tomoki Kosho
- Center for Medical Genetics, Shinshu University Hospital, Matsumoto, Japan
- Department of Medical Genetics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
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Shimohata H, Yamashita M, Ohgi K, Maruyama H, Takayasu M, Hirayama K, Kobayashi M. Clinical course and pathological findings of two late-onset Fabry hemizygous patients including mulberry cell counts after enzyme replacement therapy. CEN Case Rep 2020; 9:237-242. [PMID: 32189245 PMCID: PMC7320132 DOI: 10.1007/s13730-020-00463-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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/03/2020] [Indexed: 10/24/2022] Open
Abstract
Fabry disease is an X-linked inherited lysosomal storage disorder caused by a deficiency of α-galactosidase A activity, resulting in the intracellular accumulation of globotriaosylceramide and related glycosphingolipids. The phenotypes of Fabry disease in both males and females are grouped into two categories: the classical type and the late-onset type. The classical type shows general symptoms including angiokeratoma(s), acroparesthesia, hypohidrosis, corneal opacity, and gastrointestinal symptoms from an early age. The late-onset type shows cardiac or renal (or both) symptoms from a late age. We present herein the clinical course and pathological findings of two late-onset hemizygous Fabry patients after the initiation of enzyme replacement therapy (ERT), along with their mulberry cell counts during treatment. One patient's case was a renal-variant type without general symptoms; he showed stable renal function and mild proteinuria but little histological improvement with no change in the mulberry cell count during ERT. The other patient had a cardiac-variant type with renal pathological abnormality. He achieved a mild improvement of renal pathological findings, and his mulberry cell count gradually decreased during the treatment. These findings indicate that monitoring the mulberry cell count might help assess the efficacy of ERT, as a renal pathology tool.
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Affiliation(s)
- Homare Shimohata
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan.
| | - Marina Yamashita
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan
| | - Kentaro Ohgi
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan
| | - Hiroshi Maruyama
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan
| | - Mamiko Takayasu
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan
| | - Kouichi Hirayama
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan
| | - Masaki Kobayashi
- Department of Nephrology, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan
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Aoyama Y, Ushio Y, Yokoyama T, Taneda S, Makabe S, Nishida M, Manabe S, Sato M, Kataoka H, Tsuchiya K, Nitta K, Mochizuki T. Urinary Mulberry Cells as a Biomarker of the Efficacy of Enzyme Replacement Therapy for Fabry Disease. Intern Med 2020; 59:971-976. [PMID: 32238663 PMCID: PMC7184092 DOI: 10.2169/internalmedicine.3813-19] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Mulberry cells are often present in the urinary sediments of patients with Fabry disease (FD). We herein report two patients with FD undergoing enzyme replacement therapy (ERT). A 41-year-old man was diagnosed based on lack of α-galactosidase A activity. ERT was subsequently administered. A 40-year-old woman was diagnosed based on urinary Mulberry cells and genetic testing, and ERT was initiated. While the renal function of the male patient deteriorated, the Mulberry cells disappeared in the female patient after ERT was administered. The detection of urinary Mulberry cells can contribute to the diagnosis as well as serve as a biomarker for the response to treatment.
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Affiliation(s)
- Yumi Aoyama
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Yusuke Ushio
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Takashi Yokoyama
- Department of Clinical Laboratory Medicine, Tokyo Women's Medical University Hospital, Japan
| | - Sekiko Taneda
- Department of Pathology, Tokyo Women's Medical University, Japan
| | - Shiho Makabe
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Miki Nishida
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Shun Manabe
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Masayo Sato
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Hiroshi Kataoka
- Department of Nephrology, Tokyo Women's Medical University, Japan
- Clinical Research Division for Polycystic Kidney Disease, Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Ken Tsuchiya
- Department of Blood Purification, Tokyo Women's Medical University, Japan
| | - Kosaku Nitta
- Department of Nephrology, Tokyo Women's Medical University, Japan
| | - Toshio Mochizuki
- Department of Nephrology, Tokyo Women's Medical University, Japan
- Clinical Research Division for Polycystic Kidney Disease, Department of Nephrology, Tokyo Women's Medical University, Japan
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Nakamichi T, Miyazaki M, Nakayama K, Sato M, Akiu N, Sato T, Sato H, Ito S. Fabry's disease discovered with chance urinary mulberry cells: a case report. CEN Case Rep 2013; 2:49-52. [PMID: 28509222 DOI: 10.1007/s13730-012-0038-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 09/25/2012] [Indexed: 12/18/2022] Open
Abstract
Fabry's disease (FD) is a rare X-linked lysosomal storage disorder. Novel enzyme replacement therapy (ERT) at an early stage can slow the progression of cardiovascular and renal dysfunction. Urinary mulberry cells are occasionally found in renal FD. We report a case of variant FD in which detection of urinary mulberry cells led to an early diagnosis. A 36-year-old Japanese man was referred to our hospital because mulberry cells had been detected during urinalysis. Proteinuria and renal dysfunction were not observed. His plasma alpha-galactosidase activity was very low. Renal biopsy revealed typical foamy changes in the glomerular podocytes and tubular epithelial cells that are found in renal FD. Based on the detection of urinary mulberry cells, we successfully started ERT before the patient's renal function deteriorated. Clinical nephrologists and laboratory technicians should recognize the importance of screening for mulberry cells during urinalysis as this is a simple, inexpensive, and non-invasive method for diagnosing FD.
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