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Di Stefano V, Mancarella M, Camporeale A, Regalia A, Ferraresi M, Pisaniello M, Cassinerio E, Pieruzzi F, Motta I. Migalastat Treatment in a Kidney-Transplanted Patient with Fabry Disease and N215S Mutation: The First Case Report. Pharmaceuticals (Basel) 2021; 14:ph14121304. [PMID: 34959703 PMCID: PMC8708478 DOI: 10.3390/ph14121304] [Citation(s) in RCA: 4] [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: 11/17/2021] [Revised: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 11/22/2022] Open
Abstract
Fabry disease is a rare X-linked lysosomal storage disorder caused by mutations in the GLA gene, leading to deficient α-galactosidase A activity and, consequently, to glycosphingolipid accumulation in a wide variety of cells. Fabry disease due to N215S (c.644A>G, p.Asn215Ser) missense mutation usually results in a late-onset phenotype presenting with isolated cardiac involvement. We herein present the case of a patient with N215S mutation with cardiac involvement, namely left ventricular hypertrophy and ventricular arrhythmias, and end-stage renal disease requiring kidney transplantation. To the best of our knowledge, this is the first report of a kidney-transplanted Fabry patient treated with oral pharmacologic chaperone migalastat.
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Affiliation(s)
- Valeria Di Stefano
- UOC General Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (V.D.S.); (M.F.); (E.C.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Marta Mancarella
- Department of Emergency Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Antonia Camporeale
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy;
| | - Anna Regalia
- Division of Nephrology, Dialysis, and Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Marta Ferraresi
- UOC General Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (V.D.S.); (M.F.); (E.C.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Marco Pisaniello
- UOC Cardiologia, Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Elena Cassinerio
- UOC General Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (V.D.S.); (M.F.); (E.C.)
| | - Federico Pieruzzi
- Nephrology and Dialysis Unit, ASST-Monza, San Gerardo Hospital, 20900 Monza, Italy;
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Irene Motta
- UOC General Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (V.D.S.); (M.F.); (E.C.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-0255033493
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Abstract
BACKGROUND Fabry disease (FD) is an X-linked lysosomal storage disorder engendered by a deficiency of the enzyme α-galactosidase A, leading to systemic accumulation of glycolipids. Studies have reported that the cardiac subtype of FD has a later onset and minimal extracardiac involvement. However, whether the severity of cardiac involvement differs between the classic and cardiac subtypes of FD remains unclear. METHODS We enrolled consecutive patients with classic FD (n = 22; median age [25th-75th percentile], 47.0 [32.75-56.25] years; men, 72.7%) as well as age- and sex-matched patients with a later-onset cardiac subtype of FD who were selected from our cohort of patients with IVS4 919G>A mutation. FD was diagnosed on the basis of clinical symptoms/signs and pedigree screening of index case, plasma α-galactosidase activity, and molecular analysis. Data on clinical manifestations, laboratory findings, and echocardiogram findings were collected before enzyme replacement treatment. Disease severity was evaluated using the Mainz Severity Score Index score. RESULTS All female patients demonstrated heterozygous mutations, with five, one, and four of them showing normal α-galactosidase activity, classic FD, and cardiac subtype of FD, respectively. The distributions of left ventricular performance indices and comorbidities, including hypertension, diabetes mellitus, and dyslipidemia, were similar between the two groups. Moreover, MSSI cardiovascular scores did not differ significantly between the groups (classic vs cardiac subtype, 10.0 [2.0-12.5] vs 10.5 [9.0-15.25]; p = 0.277). CONCLUSION Cardiac manifestations are similar between patients with classic and cardiac subtype of FD.
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Affiliation(s)
- Wei-Ting Wang
- Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shih-Hsien Sung
- Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Jo-Nan Liao
- Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ting-Rong Hsu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Dau-Ming Niu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Wen-Chung Yu
- Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Address correspondence. Dr. Wen-Chung Yu, Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. Email address: (W.-C. Yu)
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Abstract
Fabry disease is an X-linked lysosomal storage disorder caused by a deficiency of α-galactosidase A and is classified into two types: classical and variant. The classical type exhibits classic manifestations, but the variant type does not and is therefore difficult to identify sometimes. A 73-year-old woman with a first episode of heart failure was admitted to our hospital. Her left ventricular wall motion was mildly reduced without hypertrophy. Urine sediment revealed mulberry cells, leading to the diagnosis of Fabry disease. In cases without typical clinical findings, urinary mulberry cells may help diagnose Fabry disease.
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Affiliation(s)
- Rina Onishi
- Cardiovascular Medicine, Nara City Hospital, Japan
| | - Koshiro Kanaoka
- Cardiovascular Medicine, Nara City Hospital, Japan
- Cardiovascular Medicine, Nara Medical University, Japan
| | | | | | | | - Kenji Onoue
- Cardiovascular Medicine, Nara Medical University, Japan
| | | | - Manabu Horii
- Cardiovascular Medicine, Nara City Hospital, Japan
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Germain DP, Brand E, Burlina A, Cecchi F, Garman SC, Kempf J, Laney DA, Linhart A, Maródi L, Nicholls K, Ortiz A, Pieruzzi F, Shankar SP, Waldek S, Wanner C, Jovanovic A. Phenotypic characteristics of the p.Asn215Ser (p.N215S) GLA mutation in male and female patients with Fabry disease: A multicenter Fabry Registry study. Mol Genet Genomic Med 2018; 6:492-503. [PMID: 29649853 PMCID: PMC6081232 DOI: 10.1002/mgg3.389] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 01/12/2018] [Accepted: 01/24/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The p.Asn215Ser or p.N215S GLA variant has been associated with late-onset cardiac variant of Fabry disease. METHODS To expand on the scarce phenotype data, we analyzed natural history data from 125 p.N215S patients (66 females, 59 males) enrolled in the Fabry Registry (NCT00196742) and compared it with data from 401 patients (237 females, 164 males) harboring mutations associated with classic Fabry disease. We evaluated interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), estimated glomerular filtration rate and severe clinical events. RESULTS In p.N215S males, mildly abnormal mean IVST and LVPWT values were observed in patients aged 25-34 years, and values gradually increased with advancing age. Mean values were similar to those of classic males. In p.N215S females, these abnormalities occurred primarily in patients aged 55-64 years. Severe clinical events in p.N215S patients were mainly cardiac (males 31%, females 8%) while renal and cerebrovascular events were rare. Renal impairment occurred in 17% of p.N215S males (mostly in patients aged 65-74 years), and rarely in females (3%). CONCLUSION p.N215S is a disease-causing mutation with severe clinical manifestations found primarily in the heart. Cardiac involvement may become as severe as in classic Fabry patients, especially in males.
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Affiliation(s)
- Dominique P. Germain
- Division of Medical GeneticsUniversity of VersaillesParis‐Saclay UniversityMontignyFrance
| | - Eva Brand
- Department of Nephrology, Hypertension and RheumatologyUniversity Hospital MünsterMünsterGermany
| | | | - Franco Cecchi
- Referral Center for CardiomyopathiesCardiothoraco‐vascular DepartmentCareggi University HospitalFlorenceItaly
| | - Scott C. Garman
- Department of Biochemistry and Molecular BiologyUniversity of Massachusetts AmherstAmherstMAUSA
| | | | - Dawn A. Laney
- Department of Human GeneticsEmory University School of MedicineAtlantaGAUSA
| | - Aleš Linhart
- Second Department of Medicine ‐ Department of Cardiovascular Medicine1st Faculty of MedicineCharles UniversityPragueCzech Republic
| | - László Maródi
- Department of Infectious and Pediatric ImmunologyUniversity of DebrecenDebrecenHungary
| | - Kathy Nicholls
- Department of NephrologyRoyal Melbourne Hospital, and Department of MedicineUniversity of MelbourneParkvilleVICAustralia
| | - Alberto Ortiz
- Unidad de DialisisIIS‐Fundación Jiménez DíazSchool of MedicineUAM, IRSIN and REDINRENMadridSpain
| | - Federico Pieruzzi
- Department of Medicine and SurgeryNephrology UnitUniversity of Milano‐BicoccaMonzaItaly
| | - Suma P. Shankar
- Department of Human GeneticsEmory University School of MedicineAtlantaGAUSA
- Department of PediatricsDivision of Genomic MedicineUC Davis School of MedicineSacramentoCAUSA
| | | | | | - Ana Jovanovic
- Mark Holland Metabolic UnitSalford Royal NHS Foundation TrustSalfordUK
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Smid BE, Hollak CEM, Poorthuis BJHM, van den Bergh Weerman MA, Florquin S, Kok WEM, Lekanne Deprez RH, Timmermans J, Linthorst GE. Diagnostic dilemmas in Fabry disease: a case series study on GLA mutations of unknown clinical significance. Clin Genet 2014; 88:161-6. [PMID: 25040344 DOI: 10.1111/cge.12449] [Citation(s) in RCA: 40] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 06/13/2014] [Accepted: 06/24/2014] [Indexed: 11/28/2022]
Abstract
Fabry disease' (FD) phenotype is heterogeneous: alpha-galactosidase A gene mutations (GLA) can lead to classical or non-classical FD, or no FD. The aim of this study is to describe pitfalls in diagnosing non-classical FD and assess the diagnostic value of plasma globotriaosylsphingosine. This is a case series study. Family 1 (p.A143T) presented with hypertrophic cardiomyopathy (HCM), absent classical FD signs, high residual alpha-galactosidase A activity (AGAL-A) and normal plasma globotriaosylsphingosine. Co-segregating sarcomeric mutations were found. Cardiac biopsy excluded FD. In family 2 (p.P60L), FD was suspected after kidney biopsy in a female with chloroquine use. Males had residual AGAL-A, no classical FD signs and minimally increased plasma globotriaosylsphingosine, indicating that p.P60L is most likely non-pathogenic. Non-specific complications and histology can be explained by chloroquine and alternative causes. Males of two unrelated families (p.R112H) show AGAL-A <5%, but slightly elevated plasma globotriaosylsphingosine (1.2-2.0 classical males >50 nmol/l). Histological evidence suggests a variable penetrance of this mutation. Patients with GLA mutations and non-specific findings such as HCM may have non-classical FD or no FD. Other (genetic) causes of FD-like findings should be excluded, including medication inducing FD-like storage. Plasma globotriaosylsphingosine may serve as a diagnostic tool, but histology of an affected organ is often mandatory.
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Affiliation(s)
- B E Smid
- Department of Endocrinology and Metabolism, Academic Medical Centre of Amsterdam, Amsterdam, The Netherlands
| | - C E M Hollak
- Department of Endocrinology and Metabolism, Academic Medical Centre of Amsterdam, Amsterdam, The Netherlands
| | - B J H M Poorthuis
- Department of Genetic Metabolic Diseases, Academic Medical Centre of Amsterdam, Amsterdam, The Netherlands
| | | | - S Florquin
- Department of Pathology, Academic Medical Centre of Amsterdam, Amsterdam, The Netherlands
| | - W E M Kok
- Department of Cardiology, Academic Medical Centre of Amsterdam, Amsterdam, The Netherlands
| | - R H Lekanne Deprez
- Department of Clinical Genetics, Academic Medical Centre of Amsterdam, Amsterdam, The Netherlands
| | - J Timmermans
- Department of Cardiology, RadboudUMC, Nijmegen, The Netherlands
| | - G E Linthorst
- Department of Endocrinology and Metabolism, Academic Medical Centre of Amsterdam, Amsterdam, The Netherlands
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