Endomyocardial biopsies in patients with left ventricular hypertrophy and a common Chinese later-onset fabry mutation (IVS4 + 919G > A)

Ting Rong Hsu, Shih Hsien Sung, Fu Pang Chang, Chia Feng Yang, Hao Chuan Liu, Hsiang Yu Lin, Chun Kai Huang, He Jin Gao, Yu Hsiu Huang, Hsuan Chieh Liao, Pi Chang Lee, An Hang Yang, Chuan Chi Chiang, Ching Yuang Lin, Wen Chung Yu, Dau Ming Niu*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

33 Scopus citations

Abstract

Background: In Taiwan, DNA-based newborn screening showed a surprisingly high incidence of a cardiac Fabry mutation (IVS4 + 919G > A). The prevalence of this mutation is too high to be believed that it is a real pathogenic mutation. The purpose of this study is to identify the cardiac pathologic characteristics in patients with left ventricular hypertrophy and this mutation. Methods and results. Endomyocardial biopsies were obtained in 22 patients (Median age: 61, males: 17; females: 5) with left ventricular hypertrophy and the IVS4 + 919G > A mutation; five patients had not received enzyme replacement therapy (ERT) before biopsy, while the other 17 patients had received ERT from 8 months to 51 months. Except for three patients who had received ERT for more than 3 years, all other patients showed significant pathological change and globotriaosylceramide (Gb3) accumulation in their cardiomyocytes. In contrast to classical Fabry patients, no Gb3 accumulation was found in the capillary endothelial cells of any of our patients. Fourteen patients (63.6%) were found to have myofibrillolysis. Conclusions: All of the untreated and most of the treated IVS4 + 919G > A patients showed typical pathological changes of Fabry disease in their cardiomyocytes. No endothelial accumulation of Gb3 was found, which is similar to the findings of several previous reports regarding later-onset Fabry disease. This result highly suggests that the IVS4 + 919G > A is a real pathogenic later-onset Fabry mutation.

Original languageEnglish
Article number96
JournalOrphanet Journal of Rare Diseases
Volume9
Issue number1
DOIs
StatePublished - 1 Jul 2014

Keywords

  • Endomyocardial biopsy
  • Enzyme replacement therapy
  • Fabry disease
  • Left ventricular hypertrophy

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