Alpha-gal syndrome: Implications for cardiovascular disease

Abstract

Alpha-gal syndrome (AGS) refers to a potentially life-threatening allergy to the molecule galactose-α1,3galactose (gal), which is expressed on most mammalian tissues but, importantly, is not expressed by humans. This syndrome can manifest as an allergic reaction to mammalian meat products, but other sources of mammalian tissue can also provoke an immune response, including injectable and implantable medical products. This syndrome has been linked to coronary atherosclerosis, and medical products that express gal are routinely used in cardiology and cardiac surgery. This article seeks to discuss potential implications of alpha syndrome as it relates to cardiovascular health and to heighten awareness in the cardiovascular community about this emerging public health issue. Prevalence of galactose-α1,3-galactoseMost mammalian species (including New World monkeys, cows, pigs, goats, horses, sheep, rabbits and mice) express the galactose-α1,3-galactose (gal) disaccharide sugar on cells and tissue surfaces 1-4 . Gal expression results from the catalytic activity of the α1,3-galactosyltransferase enzyme encoded by the glycoprotein α1,3galactosyltransferase gene (GGTA1) 1-3, 5 . Certain mammalian species, such as catarrhines (humans, apes, and Old World monkeys), do not have a functional GGTA1 gene 6-8 and correspondingly do not express gal 1, 3, 4 . Additionally, gal has been documented to be absent in fish, amphibians, reptiles, and birds 3,9,10 . The function of gal is unknown 3 , but it is clearly not essential for survival 1, 3 .