Clinical Information

Fabry disease is an X-linked recessive lysosomal storage disorder caused by a deficiency of the enzyme alpha-galactosidase A (alpha-GAL A). Reduced enzyme activity results in accumulation of glycosphingolipids in the lysosomes throughout the body, in particular the kidney, heart, and brain. Severity and onset of symptoms are dependent on the residual enzyme activity. Symptoms may include acroparesthesias (pain crises), multiple angiokeratomas, reduced or absent sweating, corneal opacity, kidney insufficiency leading to kidney failure, and cardiac and cerebrovascular disease. There are renal and cardiac variant forms of Fabry disease that may be underdiagnosed. Female patients who are heterozygous for Fabry disease can have clinical presentations ranging from asymptomatic to severely affected, and they may have alpha-GAL A activity in the normal range. The estimated incidence varies from 1 in 3000 infants detected via newborn screening to 1 in 10,000 male patients diagnosed after onset of symptoms.

Unless irreversible damage has already occurred, treatment with enzyme replacement therapy has led to significant clinical improvement in affected individuals. For this reason, early diagnosis and treatment are desirable, and in a few US states, early detection of Fabry disease through newborn screening has been implemented.

Measurement of alpha-GAL A in leukocytes (AGAW / Alpha-Galactosidase, Leukocytes), serum (AGAS / Alpha-Galactosidase, Serum), or blood spots (AGABS / Alpha-Galactosidase, Blood Spot) can reliably diagnose classic or variant Fabry disease in male patients. Molecular genetic testing is the recommended diagnostic test for female patients as alpha-GAL A may be in the normal range in an affected female patient. Molecular analysis of the GLA gene (FABRZ / Fabry Disease, Full Gene Analysis, Varies) allows for detection of the disease-causing variant in both male and female patients.

The glycosphingolipid, globotriaosylsphingosine (LGb3), may be elevated in symptomatic patients and supports a diagnosis of Fabry disease. It may also be helpful as a tool for monitoring disease progression as well as determining treatment response in known patients. In addition, measurement of LGb3, may provide additional diagnostic information in the evaluation of uncertain cases, such as in asymptomatic heterozygous female patients, individuals with novel GLA variants of unclear clinical significance, as well as asymptomatic patients identified by family screening.