High incidence of later-onset Fabry disease revealed by newborn screening

Marco Spada, Severo Pagliardini, Makiko Yasuda, Turgut Tukel, Geetha Thiagarajan, Hitoshi Sakuraba, Alberto Ponzone, Robert J. Desnick

Research output: Contribution to journalArticle

Abstract

The classic phenotype of Fabry disease, X-linked α-galactosidase A (α-Gal A) deficiency, has an estimated incidence of ∼1 in 50,000 males. The recent recognition of later-onset variants suggested that this treatable lysosomal disease is more frequent. To determine the disease incidence, we undertook newborn screening by assaying the α-Gal A activity in blood spots from 37,104 consecutive Italian male neonates. Enzyme-deficient infants were retested, and "doubly screened-positive" infants and their relatives were diagnostically confirmed by enzyme and mutation analyses. Twelve (0.03%) neonates had deficient α-Gal A activities and specific mutations, including four novel missense mutations (M511, E66G, A73V, and R118C), three missense mutations (F113L, A143T, and N215S) identified previously in later-onset patients, and one splicing defect (1VS5+1G→T) reported in a patient with the classic phenotype. Molecular modeling and in vitro overexpression of the missense mutations demonstrated structures and residual activities, which were rescued/enhanced by an α-Gal A-specific pharmacologic chaperone, consistent with mutations that cause the later-onset phenotype. Family studies revealed undiagnosed Fabry disease in affected individuals. In this population, the incidence of α-Gal A deficiency was 1 in ∼3,100, with an 11:1 ratio of patients with the later-onset:classic phenotypes. If only known disease-causing mutations were included, the incidence would be 1 in ∼4,600, with a 7:1 ratio of patients with the later-onset:classic phenotypes. These results suggest that the later-onset phenotype of Fabry disease is underdiagnosed among males with cardiac, cerebrovascular, and/or renal disease. Recognition of these patients would permit family screening and earlier therapeutic intervention. However, the higher incidence of the later-onset phenotype in patients raises ethical issues related to when screening should be performed-in the neonatal period or at early maturity, perhaps in conjunction with screening for other treatable adult-onset disorders.

Original languageEnglish
Pages (from-to)31-40
Number of pages10
JournalAmerican Journal of Human Genetics
Volume79
Issue number1
DOIs
Publication statusPublished - Jul 2006

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ASJC Scopus subject areas

  • Genetics

Cite this

Spada, M., Pagliardini, S., Yasuda, M., Tukel, T., Thiagarajan, G., Sakuraba, H., Ponzone, A., & Desnick, R. J. (2006). High incidence of later-onset Fabry disease revealed by newborn screening. American Journal of Human Genetics, 79(1), 31-40. https://doi.org/10.1086/504601