Sequelae of storage in Fabry disease - pathology and comparison with other lysosomal storage diseases

Abstract

Elleder M. Sequelae of storage in Fabry disease -pathology and comparison with other lysosomal storage disorders. Acta Paediatr 2003; Suppl 443: 46-53. Stockholm. ISSN 0803-5326 Aim: To evaluate the sequelae of the lysosomal storage of globotriaosylceramide (Gb 3 ) in a series of patients with Fabry disease. Methods: Biopsy and post-mortem samples from 12 patients with Fabry disease were examined microscopically, including, in some cases, immunohistochemistry and electron microscopy. Where possible, comparisons were made with other lysosomal storage disorders. Results: Storage of Gb 3 in cardiocytes leads commonly to progressive hypertrophy, which is a non-specific phenomenon also observed in other lysosomal storage disorders. Capillary endothelial storage was associated with a tendency for capillary basement membrane multiplication. In the single angiokeratoma studied, the basement membrane was rudimentary. Sinusoids in the adrenal cortex and liver displayed either a slight degree of storage or were unaffected. The glomeruli of the kidney exhibited focal hyalinization starting in the mesangial region. Proximal tubular cells were essentially free of lysosomal accumulation, including protein absorption droplets, despite the presence of proteinuria. In only one case, an autopsied Fabry heterozygote, were the proximal tubular cells loaded with protein absorption droplets. The arterial wall in large muscular arteries (coronary, renal and intrarenal) displayed arteriopathy with pronounced involvement of the smooth muscle cells in the media. Arteriopathy started with storage, followed by cell degeneration and breakdown, extracellular matrix deposition and, often, calcification (confined to the muscular layer). Smooth muscle cells occasionally exhibited shrinkage-type necrosis, with dispersion of the stored lipid into the dense cytoplasmic mass. Intimal and mitral valve fibroblasts exhibited variable storage, which was associated with cell loss and necrosis. Intensive storage was found in Leydig cells and in the epididymal epithelium.Conclusion: These long-term sequelae of Gb 3 storage are mostly irreversible. Some may interfere with enzyme replacement therapy. It is important, therefore, to consider starting enzyme replacement therapy as early as possible.

Replacement of α-galactosidase A in Fabry disease: effect on fibroblast cultures compared with biopsied tissues of treated patients

“…There is the undisputed role of the physical barriers, represented by fibrous stroma and basal membranes, especially when multiplied around capillaries [11]. Free access of the applied enzyme to endocytotically active cell perimeter in non-polarized cultured fibroblasts and through fenestration in the liver sinusoidal endothelium to the hepatocyte basolateral pole may contribute significantly to the effective ERT [35] (also M.E.…”

Abnormal nonstoring capillary endothelium: a novel feature of Gaucher disease. Ultrastructural study of dermal capillaries

“…The subendothelial basement membranes were frequently multiplied. In angiokeratoma of Fabry disease, in contrast, ECs were thin, despite the presence of storage lysosomes (Elleder 2003). It would be instructive to compare endothelial function and morphology in GD with Fabry disease.…”