Clinical and molecular characterization of an extended family with Fabry disease.
OBJECTIVE
To characterize clinical manifestations, biochemical changes, mutation of alpha-Galactosidase (alpha-Gal A) gene A (GLA), and functional capability of mutant protein.


METHODS
Seventeen subjects from a family with a newly diagnosed patient with Fabry disease were enrolled in the present study. In each individual, clinical history, physical examination, leukocyte enzyme activity of alpha-Gal A, and mutation analysis were performed. Those with a mutation were further investigated by ophthalmological and audiological evaluations, electrocardiography, echocardiogram, urinalysis, and blood tests to determine renal insufficiency. Expression study of the mutant protein was performed using a Pichia pastoris expression system.


RESULTS
Four affected males and five symptomatic female carriers were identified. Clinical manifestations included severe neuropathic pain, acroparesthesia, hypo-/hyper-hidrosis, frequent syncope, ischemic stroke, cardiac hypertrophy, corneal dystrophy and cart-wheel cataract, high frequency sensorineural hearing loss, periorbital edema and subcutaneous edema over hands and interphalangeal joints. None had angiokeratoma or renal symptoms. The authors identified a novel mutation, p.L106R, in the GLA gene. Recombinant expression of the mutant protein gave little or no enzyme activity compared to the normal protein.


CONCLUSIONS
There were intrafamilial clinical variabilities, but consistent findings of the absence of angiokeratoma and renal symptoms, which could represent a unique feature of this particular mutation.
Wattanasirichaigoon
Duangrurdee
D
Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. radwc@mahidol.ac.th
Svasti
Jisnuson
J
Cairns
James R Ketudat
JR
Tangnararatchakit
Kanchana
K
Visudtibhan
Anannit
A
Keeratichamroen
Siriporn
S
Ngiwsara
Lukana
L
Khowsathit
Pongsakdi
P
Onkoksoong
Tassanee
T
Lekskul
Apatsa
A
Mongkolsiri
Dowruang
D
Jariengprasert
Chanchai
C
Thawil
Cheamchit
C
Ruencharoen
Suwimol
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D019943:Amino Acid Substitution; D000794:Angiokeratoma / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D004252:DNA Mutational Analysis; D000795:Fabry Disease / Q000097:blood / Q000235:genetics* / Q000473:pathology; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D020125:Mutation, Missense; D010375:Pedigree; D051437:Renal Insufficiency / Q000209:etiology; D000519:alpha-Galactosidase / Q000097:blood / Q000235:genetics*
D000519:alpha-Galactosidase