fabry disease by farshid mokhberi
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Fabry Disease
By
Farshid mokhberi
Shahid beheshti University of Medical Sciences
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Fabry disease
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Definition: Fabry disease (also known as Fabry's
disease, Anderson-Fabry disease, angiokeratoma corporis diffusum and alpha-galactosidase A deficiency) is a rare genetic lysosomal storage disease, inherited in an X-linked manner. It is a form of sphingolipidosis, as it involves dysfunctional metabolism of sphingolipids.
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Pathophysiology
A deficiency of the enzyme alpha galactosidase A due to mutation causes a glycolipid known as globotriaosylceramide to accumulate within the blood vessels, other tissues, and organs.
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Incidence
The incidence of Fabry disease is estimated to be between 1 in 40,000 to 1 in 120,000 live births
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InheritanceXq21.3-q22
Genomic coordinates (GRCh37): X:100,652,778 - 100,663,000
The DNA mutations which cause the disease are X-linked dominant with incomplete penetrance in heterozygous females. The condition affects hemizygous males (i.e. all males), as well as homozygous, and in many cases heterozygous females.
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Gene location:
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SymptomsPain: Extremities or GI tract (Acroparesthesia)Renal involvement: ProteinuriaCardiac manifestations: Hypertension and
cardiomyopathyDermatological manifestations: Angiokeratomas,
Anhidrosis, hyperhidrosis, Raynaud's disease-like symptoms
Ocular manifestations: Keratopathy, cataracts, papilloedema, macular edema, optic atrophy
Other manifestations:Fatigue, neuropathy, tinnitus, vertigo, nausea, chemical imbalances, and diarrhea Stroke of unknown etiology in young adulthood.
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Two major signs:angiokeratoma cataract
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Raynaud's disease-like symptoms
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Diagnosis
the diagnosis can usually be confirmed in males if there is low alpha-Gal A activity in leukocytes or plasma.
Molecular genetic analysis of the GLA gene is the most accurate method of diagnosis in female.
Kidney biopsy may also be suggestive of Fabry disease if excessive lipid buildup is noted.
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Treatment
The first treatment for Fabry's disease was approved by FDA on April 24, 2003. Fabrazyme (agalsidase beta) was licensed to the Genzyme Corporation. It is an enzyme replacement therapy (ERT).
The pharmaceutical company Shire manufactures agalsidase alpha under the brand name Replagal as a treatment for Fabry's disease.
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Prognosis
males was 58.2 years, compared with 74.7 years.
females 75.4 years compared with 80.0 years in the general population, according to registry data from 2001 to 2008.
The most common cause of death was cardiovascular disease, and most of those had received kidney replacements.
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Thanks for your attention
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Reffrenses:1. http://www.uptodate.com2. http://www.myoclinic.com3. http://www.ncbi.nlm.nih.gov/pubmed4.www.geneticreaserch.com5. http://ghr.nlm.nih.gov/gene/GLA