Fabry disease, an under-recognized multisystemic disorder: expert recommendations for diagnosis, management, and enzyme replacement therapy.
Fabry disease (alpha-galactosidase A deficiency) is an X-linked recessive lysosomal storage disorder. Although the disease presents in childhood and culminates in cardiac, cerebrovascular, and end-stage renal disease, diagnosis is often delayed or missed. This paper reviews the key signs and symptoms of Fabry disease and provides expert recommendations for diagnosis, follow-up, medical management, and the use of enzyme replacement therapy. Recommendations are based on reviews of the literature on Fabry disease, results of recent clinical trials, and expertise of the authors, all of whom have extensive clinical experience with Fabry disease and lysosomal storage disorders and represent subspecialties involved in treatment. All males and female carriers affected with Fabry disease should be followed closely, regardless of symptoms or treatment status. Clinical trials have shown that recombinant human alpha-galactosidase A replacement therapy--the only disease-specific therapy currently available for Fabry disease--is safe and can reverse substrate storage in the lysosome, the pathophysiologic basis of the disease. Enzyme replacement therapy in all males with Fabry disease (including those with end-stage renal disease) and female carriers with substantial disease manifestations should be initiated as early as possible. Additional experience is needed before more specific recommendations can be made on optimal dosing regimens for reversal; maintenance; and prevention of disease manifestations in affected males, symptomatic carrier females, children, and patients with compromised renal function.
Desnick
Robert J
RJ
Department of Human Genetics, Box 1498, Mount Sinai School of Medicine, Fifth Avenue at 100th Street, New York, NY 10029, USA. rjd.fabry@mssn.edu
Brady
Roscoe
R
Barranger
John
J
Collins
Allan J
AJ
Germain
Dominique P
DP
Goldman
Martin
M
Grabowski
Gregory
G
Packman
Seymour
S
Wilcox
William R
WR
D002985:Clinical Protocols; D002986:Clinical Trials as Topic; D018450:Disease Progression; D005104:Expert Testimony; D000795:Fabry Disease / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006579:Heterozygote; D006801:Humans; D008297:Male; D011994:Recombinant Proteins / Q000627:therapeutic use; D000519:alpha-Galactosidase / Q000627:therapeutic use*
D011994:Recombinant Proteins; D000519:alpha-Galactosidase