法布里病
酶替代疗法
医学
无症状的
疾病
自然史
重症监护医学
表型
儿科
内科学
生物信息学
病理
基因
生物
遗传学
作者
Alberto Ortíz,Dominique P. Germain,Robert J. Desnick,Juan Politei,Michael Mauer,Alessandro P. Burlina,Christine M. Eng,Robert J. Hopkin,Dawn A. Laney,Aleš Linhart,Stephen Waldek,Eric Wallace,Frank Weidemann,William R. Wilcox
标识
DOI:10.1016/j.ymgme.2018.02.014
摘要
Fabry disease is an X-linked lysosomal storage disorder caused by mutations in the GLA gene leading to deficient α-galactosidase A activity, glycosphingolipid accumulation, and life-threatening complications. Phenotypes vary from the "classic" phenotype, with pediatric onset and multi-organ involvement, to later-onset, a predominantly cardiac phenotype. Manifestations are diverse in female patients in part due to variations in residual enzyme activity and X chromosome inactivation patterns. Enzyme replacement therapy (ERT) and adjunctive treatments can provide significant clinical benefit. However, much of the current literature reports outcomes after late initiation of ERT, once substantial organ damage has already occurred. Updated monitoring and treatment guidelines for pediatric patients with Fabry disease have recently been published. Expert physician panels were convened to develop updated, specific guidelines for adult patients. Management of adult patients depends on 1) a personalized approach to care, reflecting the natural history of the specific disease phenotype; 2) comprehensive evaluation of disease involvement prior to ERT initiation; 3) early ERT initiation; 4) thorough routine monitoring for evidence of organ involvement in non-classic asymptomatic patients and response to therapy in treated patients; 5) use of adjuvant treatments for specific disease manifestations; and 6) management by an experienced multidisciplinary team.
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