Afiliacje
1 Cincinnati Children’s Hospital Medical Center Division of Human Genetics, Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45 229–3026, USA;
2 Division of Medical Genetics, Department of Human Genetics, Emory University School of Medicine, 101 Woodruff Circle, Atlanta, GA, USA;
3 US Medical Affairs, Rare Diseases, Sanofi, Cambridge, MA, USA
Tłumaczyła: Magdalena Rot-Kołodziejczyk
Adres do korespondencji: Robert J. Hopkin rob.hopkin@cchmc.org
Korekta opublikowana w 2025 roku.
Otrzymano: 13 stycznia 2025 roku. Zaakceptowano: 11 lipca 2025 roku. Data publikacji: 13 sierpnia 2025 roku.
Uwagi wydawcy: Springer Nature zachowuje neutralność w kwestii roszczeń jurysdykcyjnych na opublikowanych mapach i powiązań instytucjonalnych.
Translated from Fabry disease in females: organ involvement and clinical outcomes compared with the general population, Robert J. Hopkin, Dawn Laney, Sean Kazemi, Angela Walter, Orphanet
Journal of Rare Diseases (2025) 20:433. https://doi.org/10.1186/s13023-025-03922-x. © The Author(s) 2025. corrected publication 2025. This article is an open access article distributed under the
terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Od redakcji: artykuł podzielono na części. Artykuł w druku ukazał się w numerze 1/2026 czasopisma „Medycyna Praktyczna – Neurologia”.
Nie da się dokładnie przewidzieć fenotypu u kobiet z chorobą Fabry’ego wyłącznie na podstawie genotypu. U kobiet występuje znaczna zmienność objawów, dlatego definiowanie choroby na podstawie korelacji genotypu i fenotypu jest skomplikowane.
Przypuszcza się, że inaktywacja chromosomu X u kobiet jest podstawowym czynnikiem determinującym fenotyp. Wyniki najnowszych badań oceniających związek między wzorcami inaktywacji chromosomu X i nasileniem objawów są jednak niejednoznaczne. Inaktywacja chromosomu X to proces, w którym u kobiet jeden z dwóch chromosomów X jest losowo unieczynniany, aby wyrównać liczbę kopii genów znajdujących się w chromosomie X u kobiet z dwoma chromosomami X i mężczyzn z jednym chromosomem X. U kobiet z chorobą Fabry’ego w próbkach krwi często stwierdza się niekorzystny wzór inaktywacji chromosomu X [cechujący się przeważającą inaktywacją „zdrowego” chromosomu X bez wariantu patogennego genu GLA – przyp. red.]. Taki wzór inaktywacji chromosomu X w komórkach krwi nie koreluje jednak w sposób wiarygodny z ciężkością choroby, aktywnością α‑Gal A ani stężeniem lizo‑GL‑333. Nielosowa inaktywacja chromosomu X w poszczególnych narządach u kobiet z wariantem patogennym genu GLA wpływa na aktywność α‑Gal A w danej komórce i może przyczyniać się do różnic fenotypowych18. W przeciwieństwie do mężczyzn, u kobiet ocena aktywności α‑Gal A w osoczu nie pozwala przewidzieć nasilenia zaburzeń klinicznych, ponieważ choroba ma często przebieg objawowy nawet u kobiet ze zrównoważonym wzorem inaktywacji chromosomu X i prawidłową lub niemal prawidłową aktywnością α‑Gal A w osoczu6,18.
Dla porównania, w przypadku mukopolisacharydozy typu II (MPS II), innej lizosomalnej choroby spichrzeniowej sprzężonej z chromosomem X, cechującej się niedoborem enzymu lizosomalnego iduronianu‑2‑sulfatazy prowadzącym do spichrzania glikozaminoglikanów w wielu narządach34, u kobiet – nosicielek wariantu chorobotwórczego genu IDS rzadko występują objawy z wyjątkiem uszkodzenia obu alleli lub współwystępowania innych czynników genetycznych35. Możliwym wyjaśnieniem, dlaczego u kobiet z patogennym wariantem IDS choroba zwykle przebiega bezobjawowo, podczas gdy większość kobiet z wariantem chorobotwórczym GLA wykazuje objawy, jest mechanizm korekcji krzyżowej. Polega on na tym, że komórki mające prawidłowy allel produkują i wydzielają aktywny enzym, który następnie jest wychwytywany przez sąsiednie komórki poprzez receptor mannozo‑6‑fosforanowy, co pozwala korygować niedobór metaboliczny35,36.
W 2015 roku Fuller i wsp. wykazali, że u pacjentów z MPS II możliwa jest skuteczna korekcja krzyżowa – w hodowlach fibroblastów pochodzących od chorych udało się skorygować defekt enzymatyczny, co doprowadziło do zmniejszenia nagromadzenia glikozaminoglikanów do poziomu obserwowanego w komórkach prawidłowych. Autorzy ci stwierdzili, że w przeciwieństwie do MPS II w chorobie Fabry’ego fibroblasty wytwarzające α‑Gal A wydzielają do przestrzeni pozakomórkowej lub osocza jedynie minimalne ilości tego enzymu i to w postaci dojrzałej, a nie ufosforylowanej mannozo‑6‑fosforanem [możliwej do wchłonięcia przez inne komórki – przyp. red.]. Z tego powodu nie zachodziła enzymatyczna korekcja krzyżowa w fibroblastach z niedoborem α‑Gal A36.
W nowszych badaniach morfometrycznych z wykorzystaniem materiału z biopsji nerek wykazano, że u kobiet z chorobą Fabry’ego cytoplazma podocytów* zawierająca GL‑3 jest identyczna jak u mężczyzn z tą chorobą. Sugeruje to, że podocyty u kobiet nie wykorzystują ani aktywności enzymatycznej sąsiadujących zdrowych podocytów, ani większej resztkowej aktywności α‑Gal A w osoczu, podważając hipotezę o możliwej enzymatycznej korekcji krzyżowej u kobiet z chorobą Fabry’ego38. Biorąc pod uwagę wszystkie uzyskane dane, nie dostarczają one dowodów na występowanie krzyżowej korekcji enzymatycznej między komórkami produkującymi aktywną α‑Gal A i komórkami pozbawionymi aktywnej α‑Gal A u heterozygotycznych kobiet6,39.
Występowanie ponad 1000 wariantów genu GLA przyczynia się do dużej niejednorodności choroby Fabry’ego40. Wśród nich wyróżnia się warianty patogenne związane z fenotypem klasycznym lub nieklasycznym, warianty o nieznanym znaczeniu oraz łagodne polimorfizmy6. Dodatkowo należy uwzględnić geny modyfikujące fenotyp. Z uwagi na dużą liczbę wariantów prywatnych [występujących u pojedynczych pacjentów lub w pojedynczych rodzinach – przyp. red.] trudno zgromadzić dane od odpowiedniej liczby chorych, pozwalające na pełne scharakteryzowanie fenotypów41, a brak korekcji krzyżowej między komórkami znacząco utrudnia próby ustalenia zależności między fenotypem i aktywnością α‑Gal A w osoczu lub w leukocytach12,42. Na podstawie dostępnych ograniczonych danych nie stwierdzono spójnej zależności między fenotypem i aktywnością α‑Gal A w osoczu lub leukocytach12,30,42.
Należy podkreślić, że mimo złożoności i zmienności przebiegu choroby u kobiet istnieją wyraźne różnice pod względem ryzyka poważnych zdarzeń medycznych w zależności od tego, czy dany wariant patogenny GLA wiąże się z postacią klasyczną lub nieklasyczną4.
Piśmiennictwo:
- Germain DP. Fabry disease. Orphanet J Rare Dis. 2010;5:30.
- Izhar R, Borriello M, La Russa A, Di Paola R, De A, Capasso G, et al. Fabry disease in women: genetic basis, available biomarkers, and clinical manifestations. Genes (Basel) 2023;15.
- Wilcox WR, Oliveira JP, Hopkin RJ, Ortiz A, Banikazemi M, Feldt-Rasmussen U, et al. Females with Fabry disease frequently have major organ involvement: lessons from the Fabry Registry. Mol Genet Metab. 2008;93:112-28.
- Arends M, Wanner C, Hughes D, Mehta A, Oder D, Watkinson OT, et al. Characterization of classical and nonclassical fabry disease: a multicenter study. J Am Soc Nephrol. 2017;28:1631-41.
- MacDermot KD, Holmes A, Miners AH. Anderson-Fabry disease: clinical manifestations and impact of disease in a cohort of 60 obligate carrier females. J Med Genet. 2001;38:769-75.
- Ortiz A, Germain DP, Desnick RJ, Politei J, Mauer M, Burlina A, et al. Fabry disease revisited: management and treatment recommendations for adult patients. Mol Genet Metab. 2018;123:416-27.
- Madi S, Huma F, Ahmad M, Singleton C, G. WD, Wallace E. Kidney biopsy findings in fabry females with normal serum creatinine levels (C-13). 7th update on fabry disease: biomarkers, progression and treatment opportunities in 2022. Nephron 2022;146(suppl1):1-51.
- Hopkin RJ, Bissler J, Banikazemi M, Clarke L, Eng CM, Germain DP, et al. Characterization of fabry disease in 352 pediatric patients in the fabry registry. Pediatr Res. 2008;64:550-5.
- Waldek S, Patel MR, Banikazemi M, Lemay R, Lee P. Life expectancy and cause of death in males and females with Fabry disease: findings from the Fabry Registry. Genet Med. 2009;11:790-6.
- Cole AL, Lee PJ, Hughes DA, Deegan PB, Waldek S, Lachmann RH. Depression in adults with Fabry disease: a common and under-diagnosed problem. J Inherit Metab Dis. 2007;30:943-51.
- Körver S, Geurtsen GJ, Hollak CEM, van Schaik IN, Longo MGF, Lima MR, et al. Cognitive functioning and depressive symptoms in Fabry disease: a follow-up study. J Inherit Metab Dis. 2020;43:1070-81.
- Deegan PB, Baehner AF, Barba Romero MA, Hughes DA, Kampmann C, Beck M. Natural history of Fabry disease in females in the Fabry Outcome Survey. J Med Genet. 2006;43:347-52.
- Hanneman K, Karur GR, Wasim S, Wald RM, Iwanochko RM, Morel CF. Left ventricular hypertrophy and late gadolinium enhancement at cardiac MRI are associated with adverse cardiac events in fabry disease. Radiology. 2020;294:42-9.
- Morand O, Johnson J, Walter J, Atkinson L, Kline G, Frey A, et al. Symptoms and quality of life in patients with fabry disease: results from an International Patient Survey. Adv Ther. 2019;36:2866-80.
- Schiffmann R, Warnock DG, Banikazemi M, Bultas J, Linthorst GE, Packman S, et al. Fabry disease: progression of nephropathy, and prevalence of cardiac and cerebrovascular events before enzyme replacement therapy. Nephrol Dial Transplant. 2009;24:2102-11.
- Sims K, Politei J, Banikazemi M, Lee P. Stroke in Fabry disease frequently occurs before diagnosis and in the absence of other clinical events: natural history data from the Fabry Registry. Stroke. 2009;40:788-94.
- Wilcox WR, Feldt-Rasmussen U, Martins AM, Ortiz A, Lemay RM, Jovanovic A, et al. Improvement of Fabry disease-related gastrointestinal symptoms in a significant proportion of female patients treated with agalsidase beta: data from the fabry registry. JIMD Rep. 2018;38:45-51.
- Echevarria L, Benistan K, Toussaint A, Dubourg O, Hagege AA, Eladari D, et al. X-chromosome inactivation in female patients with Fabry disease. Clin Genet. 2016;89:44-54.
- Beck M, Cox TM. Comment: Why are females with Fabry disease affected? Mol Genet Metab Rep. 2019;21: 100529.
- Chimenti C, Pieroni M, Morgante E, Antuzzi D, Russo A, Russo MA, et al. Prevalence of Fabry disease in female patients with late-onset hypertrophic cardiomyopathy. Circulation. 2004;110:1047-53.
- Mehta A, Ricci R, Widmer U, Dehout F, Garcia de Lorenzo A, Kampmann C, et al. Fabry disease defined: baseline clinical manifestations of 366 patients in the Fabry Outcome Survey. Eur J Clin Invest 2004;34:236-42.
- Lidove O, Kaminsky P, Hachulla E, Leguy-Seguin V, Lavigne C, Marie I, et al. Fabry disease “The New Great Imposter”: results of the French Observatoire in Internal Medicine Departments (FIMeD). Clin Genet. 2012;81:571-7.
- Laney DA, Peck DS, Atherton AM, Manwaring LP, Christensen KM, Shankar SP, et al. Fabry disease in infancy and early childhood: a systematic literature review. Genet Med. 2015;17:323-30.
- Laney DA, Houde MF, Foley AL, Peck DS, Atherton AM, Manwaring LP, et al. Prospective characterization of early symptom onset and progression in young pediatric patients with variants in the G LA gene across 5 years: Longitudinal data from the Fabry MOPPet Study. Genet Med Open. 2024;2: 101891.
- Wanner C, Ortiz A, Wilcox WR, Hopkin RJ, Johnson J, Ponce E, et al. Global reach of over 20 years of experience in the patient-centered Fabry Registry: advancement of Fabry disease expertise and dissemination of real-world evidence to the Fabry community. Mol Genet Metab. 2023;139: 107603.
- Barba-Romero M, Serena J, Puig JM, Valverde CV, Climent V, Herrero JA, et al. Clinical profile of women diagnosed with Fabry disease non receiving enzyme replacement therapy. Med Clin (Barc). 2019;153:47-55.
- Mursă A, Militaru S, Rusu E, Onciul S, Neculae G, Adam R, et al. Fabry disease phenotyping in women from the complete Romanian cohort-time for early diagnostic awareness. Rom J Intern Med. 2024;62(4):414-29.
- Kurschat CE. Fabry disease-what cardiologists can learn from the nephrologist: a narrative review. Cardiovasc Diagn Ther. 2021;11:672-82.
- Tomioka D, Kato K, Ozawa T, Kodama K, Takahashi H, Dochi K, et al. Diverse phenotypic expression associated with the same genetic variant in female heterozygote patients of Anderson-Fabry disease: a case series. Eur Heart J Case Rep. 2021;5:ytaa538.
- Azevedo O, Gago MF, Miltenberger-Miltenyi G, Robles AR, Costa MA, Pereira O, et al. Natural history of the late-onset phenotype of Fabry disease due to the p.F113L mutation. Mol Genet Metab Rep. 2020;22:100565.
- Schiffmann R, Hughes DA, Linthorst GE, Ortiz A, Svarstad E, Warnock DG, et al. Screening, diagnosis, and management of patients with Fabry disease: conclusions from a “Kidney Disease: Improving Global Outcomes” (KDIGO) Controversies Conference. Kidney Int. 2017;91:284-93.
- Alitter Q. Late-onset Fabry disease affecting the kidneys and liver while sparing the heart: a case report. Cureus. 2022;14: e30989.
- Wagenhäuser L, Rickert V, Sommer C, Wanner C, Nordbeck P, Rost S, Üçeyler N. X-chromosomal inactivation patterns in women with Fabry disease. Mol Genet Genomic Med. 2022;10: e2029.
- D’Avanzo F, Rigon L, Zanetti A, Tomanin R. Mucopolysaccharidosis type II: one hundred years of research, diagnosis, and treatment. Int J Mol Sci. 2020;21:1258.
- Pinto LL, Vieira TA, Giugliani R, Schwartz IV. Expression of the disease on female carriers of X-linked lysosomal disorders: a brief review. Orphanet J Rare Dis. 2010;5:14.
- Fuller M, Mellett N, Hein LK, Brooks DA, Meikle PJ. Absence of α-galactosidase cross-correction in Fabry heterozygote cultured skin fibroblasts. Mol Genet Metab. 2015;114:268-73.
- Reiser J, Sever S. Podocyte biology and pathogenesis of kidney disease. Annu Rev Med. 2013;64:357-66.
- Mauer M, Glynn E, Svarstad E, Tøndel C, Gubler MC, West M, et al. Mosaicism of podocyte involvement is related to podocyte injury in females with Fabry disease. PLoS ONE. 2014;9: e112188.
- Najafian B, Silvestroni A, Sokolovskiy A, Tøndel C, Svarstad E, Obrisca B, et al. A novel unbiased method reveals progressive podocyte globotriaosylceramide accumulation and loss with age in females with Fabry disease. Kidney Int. 2022;102:173-82.
- Germain DP, Levade T, Hachulla E, Knebelmann B, Lacombe D, Seguin VL, et al. Challenging the traditional approach for interpreting genetic variants: Lessons from Fabry disease. Clin Genet. 2022;101:390-402.
- Curiati MA, Aranda CS, Kyosen SO, Varela P, Pereira VG, D’Almeida V, et al. The challenge of diagnosis and indication for treatment in Fabry disease. J Inborn Errors Metab Screen. 2017;5:2326409816685735.
- Gupta S, Ries M, Kotsopoulos S, Schiffmann R. The relationship of vascular glycolipid storage to clinical manifestations of Fabry disease: a cross-sectional study of a large cohort of clinically affected heterozygous women. Medicine (Baltimore). 2005;84:261-8.
- Nowak A, Mechtler TP, Hornemann T, Gawinecka J, Theswet E, Hilz MJ, Kasper DC. Genotype, phenotype and disease severity reflected by serum LysoGb3 levels in patients with Fabry disease. Mol Genet Metab. 2018;123:148-53.
- Smid BE, van der Tol L, Biegstraaten M, Linthorst GE, Hollak CE, Poorthuis BJ. Plasma globotriaosylsphingosine in relation to phenotypes of Fabry disease. J Med Genet. 2015;52:262-8.
- Nowak A, Beuschlein F, Sivasubramaniam V, Kasper D, Warnock DG. Lyso-Gb3 associates with adverse long-term outcome in patients with Fabry disease. J Med Genet. 2022;59:287-93.
- van der Veen SJ, Sayed ME, Hollak CEM, Brands MM, Snelder CKS, Boekholdt SM, et al. Early risk stratification for natural disease course in Fabry patients using plasma globotriaosylsphingosine levels. Clin J Am Soc Nephrol. 2023;18:1272-82.
- Wanner C, Oliveira JP, Ortiz A, Mauer M, Germain DP, Linthorst GE, et al. Prognostic indicators of renal disease progression in adults with Fabry disease: natural history data from the Fabry Registry. Clin J Am Soc Nephrol. 2010;5:2220-8.
- Arias E, Tejada-Vera B, Kochanek KD, Ahmad F. Provisional Life Expectancy Estimates for 2021. 2022.https:// www. cdc. gov/ nchs/ data/ vsrr/vsrr0 23. pdf. Accessed June 2024.
- Namdar M. Electrocardiographic changes and arrhythmia in Fabry disease. Front Cardiovasc Med. 2016;3:7.
- Weidemann F, Sanchez-Niño MD, Politei J, Oliveira JP, Wanner C, Warnock DG, Ortiz A. Fibrosis: a key feature of Fabry disease with potential therapeutic implications. Orphanet J Rare Dis. 2013;8:116.
- Weidemann F, Strotmann JM, Niemann M, Herrmann S, Wilke M, Beer M, et al. Heart valve involvement in Fabry cardiomyopathy. Ultrasound Med Biol. 2009;35:730-5.
- Wilson HC, Hopkin RJ, Madueme PC, Czosek RJ, Bailey LA, Taylor MD, Jefferies JL. Arrhythmia and clinical cardiac findings in children with Anderson-Fabry disease. Am J Cardiol. 2017;120:251-5.
- Mathur S, Dreisbach JG, Karur GR, Iwanochko RM, Morel CF, Wasim S, et al. Loss of base-to-apex circumferential strain gradient assessed by cardiovascular magnetic resonance in Fabry disease: relationship to T1 mapping, late gadolinium enhancement and hypertrophy. J Cardiovasc Magn Reson. 2019;21:45.
- Yogasundaram H, Kim D, Oudit O, Thompson RB, Weidemann F, Oudit GY. Clinical features, diagnosis, and management of patients with Anderson-Fabry cardiomyopathy. Can J Cardiol. 2017;33:883-97.
- Nordin S, Kozor R, Vijapurapu R, Augusto JB, Knott KD, Captur G, et al. Myocardial storage, inflammation, and cardiac phenotype in Fabry disease after one year of enzyme replacement therapy. Circ Cardiovasc Imaging. 2019;12: e009430.
- Germain DP, Brand E, Burlina A, Cecchi F, Garman SC, Kempf J, et al. Phenotypic characteristics of the p.Asn215Ser (p.N215S) GLA mutation in male and female patients with Fabry disease: a multicenter Fabry Registry study. Mol Genet Genomic Med. 2018;6:492-503.
- Liu HC, Perrin A, Hsu TR, Yang CF, Lin HY, Yu WC, Niu DM. Age at first cardiac symptoms in Fabry disease: association with a Chinese hotspot Fabry mutation (IVS4+919G>A), classical fabry mutations, and sex in a Taiwanese population from the Fabry Outcome Survey (FOS). JIMD Rep. 2015;22:107-13.
- Fan Y, Chan TN, Chow JTY, Kam KKH, Chi WK, Chan JYS, et al. High prevalence of late-on-set fabry cardiomyopathy in a cohort of 499 non-selective patients with left ventricular hypertrophy: The Asian Fabry cardiomyopathy high-risk screening study (ASIAN-FAME). J Clin Med. 2021;10:2160.
- Sánchez R, Ripoll-Vera T, López-Mendoza M, de Juan-Ribera J, Gimeno JR, Hermida Á, et al. The Spanish Fabry women study: a retrospective observational study describing the phenotype of females with GLA variants. Orphanet J Rare Dis. 2023;18:8.
- El Sayed M, Hirsch A, Boekholdt M, van Dussen L, Datema M, Hollak C, Langeveld M. Influence of sex and phenotype on cardiac outcomes in patients with Fabry disease. Heart. 2021;107:1889-97.
- Lakshminarayan K, Solid CA, Collins AJ, Anderson DC, Herzog CA. Atrial fibrillation and stroke in the general medicare population: a 10-year perspective (1992 to 2002). Stroke. 2006;37:1969–74.
- Dresing TJ, Wikoff BL. Bradyarrhythmias. Curr Treat Options Cardiovasc Med. 2001;3:291-8.
- Lobo T, Morgan J, Bjorksten A, Nicholls K, Grigg L, Centra E, Becker G. Cardiovascular testing in Fabry disease: exercise capacity reduction, chronotropic incompetence and improved anaerobic threshold after enzyme replacement. Intern Med J. 2008;38:407-14.
- Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, Singer DE. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285:2370-5.
- Linhart A, Kampmann C, Zamorano JL, Sunder-Plassmann G, Beck M, Mehta A, et al. Cardiac manifestations of Anderson-Fabry disease: results from the international Fabry outcome survey. Eur Heart J. 2007;28:1228-35.
- Kampmann C, Baehner F, Whybra C, Martin C, Wiethoff CM, Ries M, et al. Cardiac manifestations of Anderson-Fabry disease in heterozygous females. J Am Coll Cardiol. 2002;40:1668-74.
- Schirmer H, Lunde P, Rasmussen K. Prevalence of left ventricular hypertrophy in a general population. The Tromsø Study Eur Heart J. 1999;20:429-38.
- Baig S, Edward NC, Kotecha D, Liu B, Nordin S, Kozor R, et al. Ventricular arrhythmia and sudden cardiac death in Fabry disease: a systematic review of risk factors in clinical practice. Europace. 2018;20:f153-61.
- Hung CL, Wu YW, Lin CC, Lai CH, Jyh-Ming Juang J, Chao TH, et al. 2021 TSOC expert consensus on the clinical features, diagnosis, and clinical management of cardiac manifestations of Fabry Disease. Acta Cardiol Sin. 2021;37:337-54.
- Niemann M, Herrmann S, Hu K, Breunig F, Strotmann J, Beer M, et al. Differences in Fabry cardiomyopathy between female and male patients: consequences for diagnostic assessment. JACC Cardiovasc Imaging. 2011;4:592-601.
- Hsu TR, Hung SC, Chang FP, Yu WC, Sung SH, Hsu CL, et al. Later onset Fabry disease, cardiac damage progress in silence: experience with a highly prevalent mutation. J Am Coll Cardiol. 2016;68:2554-63.
- Disertori M, Masè M, Ravelli F. Myocardial fibrosis predicts ventricular tachyarrhythmias. Trends Cardiovasc Med. 2017;27:363-72.
- Orsborne C, Bradley J, Bonnett LJ, Pleva LA, Naish JH, Clark DG, et al. Validated model for prediction of adverse cardiac outcome in patients with Fabry disease. J Am Coll Cardiol. 2022;80:982-94.
- Chang HC, Kuo L, Sung SH, Niu DM, Yu WC. Prognostic implications of left ventricular hypertrophy and mechanical function in Fabry disease: a longitudinal cohort study. J Am Soc Echocardiogr. 2024;37:787-96.
- Feustel A, Hahn A, Schneider C, Sieweke N, Franzen W, Gündüz D, et al. Continuous cardiac troponin I release in Fabry disease. PLoS ONE. 2014;9: e91757.
- Torralba-Cabeza M, Olivera S, Hughes DA, Pastores GM, Mateo RN, Pérez-Calvo JI. Cystatin C and NT-proBNP as prognostic biomarkers in Fabry disease. Mol Genet Metab. 2011;104:301-7.
- Augusto JB, Nordin S, Vijapurapu R, Baig S, Bulluck H, Castelletti S, et al. Myocardial edema, myocyte injury, and disease severity in Fabry disease. Circ Cardiovasc Imaging. 2020;13: e010171.
- Powell AW, Jefferies JL, Hopkin RJ, Mays WA, Goa Z, Chin C. Cardiopulmonary fitness assessment on maximal and submaximal exercise testing in patients with Fabry disease. Am J Med Genet A. 2018;176:1852-7.
- Wang RY, Lelis A, Mirocha J, Wilcox WR. Heterozygous Fabry women are not just carriers, but have a significant burden of disease and impaired quality of life. Genet Med. 2007;9:34-45.
- Mehta A, Clarke JT, Giugliani R, Elliott P, Linhart A, Beck M, Sunder-Plassmann G. Natural course of Fabry disease: changing pattern of causes of death in FOS—Fabry Outcome Survey. J Med Genet. 2009;46:548-52.
- Sparks JA, Chang SC, Liao KP, Lu B, Fine AR, Solomon DH, et al. Rheumatoid arthritis and mortality among women during 36 years of prospective follow-up: results from the Nurses’ Health Study. Arthritis Care Res (Hoboken). 2016;68:753-62.
- Centers for Disease Control and Prevention. Leading Causes of Death−Females—All races and origins—United States, 2017. Accessed: https:// www. cdc. gov/ women/ lcod/ 2017/ all- races- origi ns/ index. htm. 2017.https:// www. cdc. gov/ women/ lcod/ 2017/ all- races- origi ns/ index.htm. Accessed July 2022.
- Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, et al. Heart disease and stroke statistics-2023 update: a report from the American Heart Association. Circulation. 2023;147:e93-621.
- Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, et al. Heart disease and stroke statistics—2021 update. Circulation. 2021;143:e254-743.
- American Heart Association. 2021 Heart Disease & Stroke Statistical Update Fact Sheet Females & Cardiovascular Diseases. 2021.https://www. heart. org/-/ media/ phd- files-2/ scien ce- news/2/ 2021- heart- andstroke-stat- update/ 2021_ stat_ update_ facts heet_ femal es_ and_ cvd.pdf? la= en. Accessed June 2024.
- Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation. 2019;139:e56-528.
- Clausen H, Theophilos T, Jackno K, Babl FE. Paediatric arrhythmias in the emergency department. Emerg Med. 2012;29:732-7.
- Khurshid S, Choi SH, Weng LC, Wang EY, Trinquart L, Benjamin EJ, et al. Frequency of cardiac rhythm abnormalities in a half million adults. Circ Arrhythm Electrophysiol. 2018;11: e006273.
- Politei JM, Bouhassira D, Germain DP, Goizet C, Guerrero-Sola A, Hilz MJ, et al. Pain in Fabry disease: practical recommendations for diagnosis and treatment. CNS Neurosci Ther. 2016;22:568-76.
- Kolodny E, Fellgiebel A, Hilz MJ, Sims K, Caruso P, Phan TG, et al. Cerebrovascular involvement in Fabry disease: current status of knowledge. Stroke. 2015;46:302-13.
- Soliman MY, El-Abassi R, England JD. Diagnosing and treatment of Fabry’s disease from a neurologic perspective. J Rare Dis Res Treat. 2016;2:12-8.
- Shi Q, Chen J, Pongmoragot J, Lanthier S, Saposnik G. Prevalence of Fabry disease in stroke patients–a systematic review and meta-analysis. J Stroke Cerebrovasc Dis. 2014;23:985-92.
- Bots ML, van der Wilk EC, Koudstaal PJ, Hofman A, Grobbee DE. Transient neurological attacks in the general population. Prevalence, risk factors, and clinical relevance. Stroke. 1997;28:768-73.
- Körver S, Vergouwe M, Hollak CEM, van Schaik IN, Langeveld M. Development and clinical consequences of white matter lesions in Fabry disease: a systematic review. Mol Genet Metab. 2018;125:205-16.
- Centers for Disease Control and Prevention. Cerebrovascular Disease or Stroke: Summary Health Statistics Tables for U.S. Adults: National Health Interview Survey, 2018, Tables A-1a. 2018.https:// ftp. cdc. gov/ pub/Health_ Stati stics/ NCHS/ NHIS/ SHS/ 2018_ SHS_ Table_A- 1. pdf. AccessedJune 2024.
- Fogo AB, Bostad L, Svarstad E, Cook WJ, Moll S, Barbey F, et al. Scoring system for renal pathology in Fabry disease: report of the International Study Group of Fabry Nephropathy (ISGFN). Nephrol Dial Transplant. 2010;25:2168-77.
- Tøndel C, Bostad L, Hirth A, Svarstad E. Renal biopsy findings in children and adolescents with Fabry disease and minimal albuminuria. Am J Kidney Dis. 2008;51:767-76.
- Gheith O, Farouk N, Nampoory N, Halim MA, Al-Otaibi T. Diabetic kidney disease: world wide difference of prevalence and risk factors. J Nephropharmacol. 2016;5:49-56.
- Mohan V, Meera R, Premalatha G, Deepa R, Miranda P, Rema M. Frequency of proteinuria in type 2 diabetes mellitus seen at a diabetes centre in southern India. Postgrad Med J. 2000;76:569-73.
- Ibrahim HN, Foley R, Tan L, Rogers T, Bailey RF, Guo H, et al. Long-term consequences of kidney donation. N Engl J Med. 2009;360:459-69.
- Glass RB, Astrin KH, Norton KI, Parsons R, Eng CM, Banikazemi M, Desnick RJ. Fabry disease: renal sonographic and magnetic resonance imaging findings in affected males and carrier females with the classic and cardiac variant phenotypes. J Comput Assist Tomogr. 2004;28:158-68.
- Ortiz A, Cianciaruso B, Cizmarik M, Germain DP, Mignani R, Oliveira JP, et al. End-stage renal disease in patients with Fabry disease: natural history data from the Fabry Registry. Nephrol Dial Transplant. 2010;25:769-75.
- Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2021. 2021.https:// www. cdc. gov/ kidney- disea se/php/ data- resea rch/? CDC_ AAref_ Val= https:// www. cdc. gov/ kidne ydise ase/ publi catio ns- resou rces/ ckd- natio nal- facts. html. Accessed June 2024.
- Neild GH. Life expectancy with chronic kidney disease: an educational review. Pediatr Nephrol. 2017;32:243-8.
- Chadban SJ, Briganti EM, Kerr PG, Dunstan DW, Welborn TA, Zimmet PZ, Atkins RC. Prevalence of kidney damage in Australian adults: The AusDiab kidney study. J Am Soc Nephrol. 2003;14:S131-8.
- Saydah SH, Xie H, Imperatore G, Burrows NR, Pavkov ME. Trends in Albuminuria and GFR among adolescents in the United States, 1988–2014. Am J Kidney Dis. 2018;72:644-52.
- Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney Int Suppl. 2022;12:7-11.
- Stevens PE, O’Donoghue DJ, de Lusignan S, Van Vlymen J, Klebe B, Middleton R, et al. Chronic kidney disease management in the United Kingdom: NEOERICA project results. Kidney Int. 2007;72:92-9.
- Bugescu N, Naylor PE, Hudson K, Aoki CD, Cordova MJ, Packman W. The psychosocial impact of fabry disease on pediatric patients. J Pediatr Genet. 2016;5:141-9.
- Bouwman MG, Rombach SM, Schenk E, Sweeb A, Wijburg FA, Hollak CE, Linthorst GE. Prevalence of symptoms in female Fabry disease patients: a case-control survey. J Inherit Metab Dis. 2012;35:891-8.
- Sandler RS, Stewart WF, Liberman JN, Ricci JA, Zorich NL. Abdominal pain, bloating, and diarrhoea in the United States. Dig Dis Sci. 2000;45:1166-71.
- Coates MD, Lahoti M, Binion DG, Szigethy EM, Regueiro MD, Bielefeldt K. Abdominal pain in ulcerative colitis. Inflamm Bowel Dis. 2013;19:2207-14.
- DiBonaventura MD, Sadosky A, Concialdi K, Hopps M, Kudel I, Parsons B, et al. The prevalence of probable neuropathic pain in the US: results from a multimodal general-population health survey. J Pain Res. 2017;10:2525-38.
- Gibas AL, Klatt R, Johnson J, Clarke JT, Katz J. A survey of the pain experienced by males and females with Fabry disease. Pain Res Manag. 2006;11:185-92.
- Street NJ, Yi MS, Bailey LA, Hopkin RJ. Comparison of health-related quality of life between heterozygous women with Fabry disease, a healthy control population, and patients with other chronic disease. Genet Med. 2006;8:346-53.
- Arends M, Körver S, Hughes DA, Mehta A, Hollak CEM, Biegstraaten M. Phenotype, disease severity and pain are major determinants of quality of life in Fabry disease: results from a large multicenter cohort study. J Inherit Metab Dis. 2018;41:141-9.
- Baehner F, Kampmann C, Whybra C, Miebach E, Wiethoff CM, Beck M. Enzyme replacement therapy in heterozygous females with Fabry disease: results of a phase IIIB study. J Inherit Metab Dis. 2003;26:617-27.
- Polistena B, Rigante D, Sicignano LL, Verrecchia E, Manna R, d’Angela D, Spandonaro F. Survey about the quality of life of Italian patients with Fabry disease. Diseases. 2021;9:72.
- Huguet A, Miró J. The severity of chronic pediatric pain: an epidemiological study. J Pain. 2008;9:226-36.
- Zelaya CE, Dahlhamer JM, Lucas JW, Connor EM. Chronic Pain and Highimpact Chronic Pain Among U.S. Adults, 2019. 2020.https:// www. cdc.gov/ nchs/ data/ datab riefs/ db390-H. pdf. Accessed June 2024.
- Almario CV, Ballal ML, Chey WD, Nordstrom C, Khanna D, Spiegel BMR. Burden of gastrointestinal symptoms in the United States: results of a Nationally Representative Survey of Over 71,000 Americans. Am J Gastroenterol. 2018;113:1701-10.
- Laney DA, Gruskin DJ, Fernhoff PM, Cubells JF, Ousley OY, Hipp H, Mehta AJ. Socialadaptive and psychological functioning of patients affected by Fabry disease. J Inherit Metab Dis. 2010;33(Suppl 3):S73-81.
- Ali N, Gillespie S, Laney D. Treatment of depression in adults with Fabry disease. JIMD Rep. 2018;38:13-21.
- Körver S, Geurtsen GJ, Hollak CEM, van Schaik IN, Longo MGF, Lima MR, et al. Depressive symptoms in Fabry disease: the importance of coping, subjective health perception and pain. Orphanet J Rare Dis. 2020;15:28.
- National Institute of Mental Health. Major depression. 2023.https://www. nimh. nih. gov/ health/ stati stics/ major- depre ssion. Accessed June 2024.
- Ali N, Caceres A, Hall EW, Laney D. Attention deficits and ADHD symptoms in adults with Fabry disease-a pilot investigation. J Clin Med. 2021;10:3367.
- Duning T, Deppe M, Keller S, Schiffbauer H, Stypmann J, Böntert M, et al. Excessive daytime sleepiness is a common symptom in Fabry disease. Case Rep Neurol. 2009;1:33-40.
- Pihlstrøm HK, Weedon-Fekjær MS, Bjerkely BL, von der Lippe C, Ørstavik K, Mathisen P, et al. Health-related quality of life in Norwegian adults with Fabry disease: Disease severity, pain, fatigue and psychological distress. JIMD Rep. 2021;62:56-69.
- Laney DA, Clarke V, Foley A, Hall EW, Gillespie SE, Holida M, et al. The impact of Fabry disease on reproductive fitness. JIMD Rep. 2017;37:85-97.
- Holmes A, Laney D. A retrospective survey studying the impact of Fabry disease on pregnancy. JIMD Rep. 2015;21:57-63.
- Mersebach H, Johansson JO, Rasmussen AK, Bengtsson BA, Rosenberg K, Hasholt L, et al. Osteopenia: a common aspect of Fabry disease. Predictors of bone mineral density. Genet Med 2007;9:812-8.
- The ESHRE Capri Workshop Group. Hormones and cardiovascular health in women. Hum Reprod Update. 2006;12:483-97.
- Cappola AR, Desai AS, Medici M, Cooper LS, Egan D, Sopko G, et al. Thyroid and cardiovascular disease: research agenda for enhancing knowledge, prevention, and treatment. Thyroid. 2019;29:760-77.
- American Thyroid Association. General Information/Press Room. https:// www.thyroid.org/ media-main/ press-room/. Accessed June 2024.
- Biondi B, Palmieri EA, Lombardi G, Fazio S. Effects of thyroid hormone on cardiac function - the relative importance of heart rate, loading conditions, and myocardial contractility in the regulation of cardiac performance in human hyperthyroidism. J Clin Endocrinol Metab. 2002;87:968-74.
- Zhu D, Chung HF, Dobson AJ, Pandeya N, Giles GG, Bruinsma F, et al. Age at natural menopause and risk of incident cardiovascular disease: a pooled analysis of individual patient data. Lancet Public Health. 2019;4:e553-64.