Fabry and Cardiomyopathy (FaCard) (FaCard)

Fabry and Cardiomyopathy (FaCard) Epidemiological Study for the Analysis of Biomarkers and the Clinical Course of Patients With Fabry Disease and the N215S-mutation An Internationa,Multicenter, Epidemiological Study

Primary objective and endpoint is the analysis of the long-term course of lyso-Gb3 and its clinical correlation to the progression of the cardiomyopathy in N215S-Fabry patients.

Study Overview

• Status: Withdrawn
• Conditions: Stroke, Acute; Cerebrovascular Accident; Cerebral Stroke

Detailed Description

Fabry disease is an X-linked lysosomal disorder that leads to excessive deposition of neutral glycosphingolipids in the vascular endothelium of several organs in the body. Progressive endothelial accumulation of glycosphingolipids accounts for the associated clinical abnormalities of skin, eye, kidney, heart, brain, and peripheral nervous system. Fabry disease manifesting predominantly in men. Female heterozygotes also present with features of Fabry disease. It is suggested that the mean age of hemizygotic men at the onset of symptomatic stroke is 29 - 34 years. The mean age of female heterozygotes at the onset of symptomatic strokes is 40 - 43 years.In Europe the prevalence of Fabry disease seems to be massively underrepresented; actual textbooks describe 1 per 40.000. However, recent data (Lin HY, et al., 2009) demonstrate the identification of eight different mutations in the alpha-galactosidase A (alpha-Gal A) gene in 110 027 newborns who were screened by assaying the alpha-Gal A activity followed by genetic analysis. Hwu and co-workers (2009) have shown in 90,288 male newborns screened for Fabry disease that 73 males had GLA gene mutations. Surprisingly, 86% had the c.936+919G>A (also called IVS4+919G>A) splice mutation. In contrast, screening 81,689 females detected two heterozygotes. Summarizing, newborn screening identified a surprisingly high frequency of Taiwanese males with Fabry disease (approximately 1 in 1,250), 86% having the IVS4+919G>A mutation previously found in later-onset cardiac phenotype patients.The late-onset mutation N215S is discussed to be a so-called cardiac variant (Perry Elliott, 2006; Eng et al., 1993, Sachdev et al., 2002). The prevalence of most mutations is low, i.e. Fabry disease spontaneously and individually inheriting so-called private mutations. However, there are some mutations that occur more frequent. Besides for instance R112H, A143T and R227X, also N215S belongs to this group (Dobrovolny et al., ASHG Abstract, 2008). The enzyme activity is only moderately affected, but hemizygous patients display a clearly decreased activity in leucocytes and fibroblasts.

In 2005, Young and colleagues (Acta Paediatr Suppl.) concluded that Gb3 is not an ideal biomarker using the example of N215S. All heterozygotes were unconspicuous and only 50% of the examined hemizygotes had increased levels. However, globotraosylceramid (lyso Gb3) seems to reveal all (genetically) found patients with a pathologically elevated level (with a mean of 1,17ng/ml (females) and 2,43ng/ml (males) respectively).

In a case study from 2004 (Meehan et al., American Journal of Kidney Diseases) was shown that a hemizygous male 75 years of age had a renal manifestation of mild proteinuria and a mildly decreased renal function due to high Gb3 accumulation in podocytes, to a lesser extent in tubular endothelial cells. Furthermore, he had mild congestive heart failure, a reduced left ventricular ejection fraction, and hypercholesterolemia. Thus, it is obvious that in Fabry patients with the N215S mutation disease progression can be mono- to oligosymptomatic, but show a tendency for the cardiac and renal phenotype rather than classical manifestation.

• Study Type: Observational

Contacts and Locations

Study Locations

• Germany
  • Rostock, Germany, 18147
    • University of Rostock, Albrecht-Kossel-Institute for Neuroregeneration

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

All Patients with a diagnosis of Fabry disease with N215S

Description

Inclusion Criteria:

• All patients of both gender from 18 years of age with a diagnosis of Fabry disease with the mutation N215S
• Written informed consent from patient

Exclusion Criteria:

• Patients without a diagnosis of Fabry disease
• No written informed consent

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Observation; All Patients with a diagnosis of Fabry disease with N215S

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
analysis of the long-term course of lyso-Gb3 and its clinical correlation to the progression of the cardiomyopathy in N215S-Fabry patients	24 month

Collaborators and Investigators

• Sponsor: CENTOGENE GmbH Rostock

Study record dates

Study Major Dates

• Study Start (Actual): July 1, 2011
• Primary Completion (Actual): December 1, 2019
• Study Completion (Actual): December 1, 2019

Study Registration Dates

• First Submitted: September 6, 2011
• First Submitted That Met QC Criteria: September 6, 2011
• First Posted (Estimate): September 7, 2011

Study Record Updates

• Last Update Posted (Actual): April 9, 2021
• Last Update Submitted That Met QC Criteria: April 8, 2021
• Last Verified: April 1, 2020

More Information

Terms related to this study

• Keywords: Cerebrovascular Accident; Fabry Disease; Cerebral Stroke; Stroke, Acute; Cerebrovascular Accident, Acute; Fabry´s Disease; Anderson-Fabry Disease; CVA (Cerebrovascular Accident)
• Additional Relevant MeSH Terms: Heart Diseases; Cardiovascular Diseases; Vascular Diseases; Metabolic Diseases; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Genetic Diseases, Inborn; Genetic Diseases, X-Linked; Metabolism, Inborn Errors; Lysosomal Storage Diseases; Lipid Metabolism Disorders; Brain Diseases, Metabolic; Brain Diseases, Metabolic, Inborn; Sphingolipidoses; Lysosomal Storage Diseases, Nervous System; Cerebral Small Vessel Diseases; Lipidoses; Lipid Metabolism, Inborn Errors; Stroke; Cardiomyopathies; Fabry Disease
• Other Study ID Numbers: FaCard06/2011

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED