Genetic Screening of Anderson-Fabry Disease in Probands Referred From Multispecialty Clinics

• Published in: Journal of the American College of Cardiology Vol. 68; no. 10; pp. 1037 - 1050
• Main Authors: Favalli, Valentina, Disabella, Eliana, Molinaro, Mariadelfina, Tagliani, Marilena, Scarabotto, Anna, Serio, Alessandra, Grasso, Maurizia, Narula, Nupoor, Giorgianni, Carmela, Caspani, Clelia, Concardi, Monica, Agozzino, Manuela, Giordano, Calogero, Smirnova, Alexandra, Kodama, Takahide, Giuliani, Lorenzo, Antoniazzi, Elena, Borroni, Riccardo G., Vassallo, Camilla, Mangione, Filippo, Scelsi, Laura, Ghio, Stefano, Pellegrini, Carlo, Zedde, Marialuisa, Fancellu, Laura, Sechi, GianPietro, Ganau, Antonello, Piga, Stefania, Colucci, Annarita, Concolino, Daniela, Di Mascio, Maria Teresa, Toni, Danilo, Diomedi, Marina, Rapezzi, Claudio, Biagini, Elena, Marini, Massimiliano, Rasura, Maurizia, Melis, Maurizio, Nucera, Antonia, Guidetti, Donata, Mancuso, Michelangelo, Scoditti, Umberto, Cassini, Pamela, Narula, Jagat, Tavazzi, Luigi, Arbustini, Eloisa
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 06.09.2016; Elsevier BV; Elsevier Limited
• Subjects: Adolescent; Adult; alpha-Galactosidase; alpha-Galactosidase - genetics; biochemical; Biopsy; Cardiology; Cardiomyopathy; Cardiovascular; Celiac disease; Child; Deoxyribonucleic acid; Dermatology; Disease; DNA; Enzymes; Fabry Disease; Fabry Disease - diagnosis; Fabry Disease - genetics; family screening; Female; Gastroenterology; Genes; Genetic counseling; Genetic Testing; Genotype & phenotype; GLA; GLA; MOGE(S) classification; biochemical; family screening; multidisciplinary evaluation; α-Gal; Hospitals; Humans; Internal medicine; Male; Medicine; Middle Aged; MOGE(S) classification; multidisciplinary evaluation; Mutation; Nephrology; NMR; Nuclear magnetic resonance; Pain; Pediatrics; Plasma; Prospective Studies; Settore MED/03 - GENETICA MEDICA; Settore MED/26 - NEUROLOGIA; Stroke; Studies; α-Gal; family screening; biochemical; MOGE(S) classification; LV; α-Gal; PBMC; TIA; multidisciplinary evaluation; Gal; HCM; WML; Gb3; GLA; AFD; LVH; Anderson-Fabry disease; globotriaosylceramide; left ventricle; peripheral blood mononuclear cell(s); transient ischemic attack; galactosidase A (enzyme); left ventricular hypertrophy; hypertrophic cardiomyopathy; white matter lesions
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2016.05.090

Anderson-Fabry disease (AFD) is a rare X-linked lysosomal storage disease, caused by defects of the alpha-galactosidase A (GLA) gene. AFD can affect the heart, brain, kidney, eye, skin, peripheral nerves, and gastrointestinal tract. Cardiology (hypertrophic cardiomyopathy), neurology (cryptogenic stroke), and nephrology (end-stage renal failure) screening studies suggest the prevalence of GLA variants is 0.62%, with diagnosis confirmation in 0.12%. This study sought to expand screening from these settings to include ophthalmology, dermatology, gastroenterology, internal medicine, pediatrics, and medical genetics to increase diagnostic yield and comprehensively evaluate organ involvement in AFD patients. In a 10-year prospective multidisciplinary, multicenter study, we expanded clinical, genetic, and biochemical screening to consecutive patients enrolled from all aforementioned clinical settings. We tested the GLA gene and α-galactosidase A activity in plasma and leukocytes. Inclusion criteria comprised phenotypical traits and absence of male-to-male transmission. Screening was extended to relatives of probands harboring GLA mutations. Of 2,034 probands fulfilling inclusion criteria, 37 (1.8%) were carriers of GLA mutations. Cascade family screening identified 60 affected relatives; clinical data were available for 4 affected obligate carriers. Activity of α-galactosidase A in plasma and leukocytes was diagnostic in male subjects, but not in female subjects. Of the 101 family members harboring mutations, 86 were affected, 10 were young healthy carriers, and 5 refused clinical evaluation. In the 86 patients, involved organs or organ systems included the heart (69%), peripheral nerves (46%), kidney (45%), eye (37%), brain (34%), skin (32%), gastrointestinal tract (31%), and auditory system (19%). Globotriaosylceramide accumulated in organ-specific and non-organ-specific cells in atypical and classic variants, respectively. Screening probands with clinically suspected AFD significantly increased diagnostic yield. The heart was the organ most commonly involved, independent of the clinical setting in which the patient was first evaluated.