Abstract
BackgroundFabry disease (FD) remains poorly recognized, especially in children in China. Considering the diversity and nonspecific clinical manifestations accompanying with life-threatening aspect of this disease, methods to improve effective screening and management of the suspects are needed. This study aims to explore how it can be done effectively from a multidisciplinary perspective for children with FD at a tertiary children’s hospital in China.MethodsA multidisciplinary team (MDT) of pediatric FD experts was launched at Children’s Hospital of Fudan University. Children with high-risk characteristics were referred by the MDT screening team using the dried blood spot (DBS) triple-test (α-galactosidase A, globotriaosylsphingosine, GLA gene). For newborns who were undergoing genetic testing in the hospital, the GLA gene was listed as a routine analysis gene. Evaluation, family screening, and genetic counselling were implemented after screening by the MDT management team.ResultsBefore the establishment of the MDT, no case was diagnosed with FD in the hospital. However, twelve months following the MDT program's implementation, thirty-five children with high-risk profiles were referred for screening by DBS triple-test, with a yield of diagnosis of 14.3% (5/35). These 5 diagnosed children were referred due to a high-risk profile of pain accompanied by dermatological angiokeratoma and hypohidrosis (n = 2), pain accompanied by abnormal liver function (n = 1), pain only (n = 1), and unexplained renal tubular dysfunction (n = 1). Two neonates were detected early with GLA mutations in the hospital, with a yield of detection of 0.14% (2/1420). Furthermore, another 3 children diagnosed with FD were referred from other hospitals. Family screening of these 10 diagnosed children indicated that 9 boys inherited it from their mothers and 1 girl inherited it from her father. Four of them started to receive enzyme replacement therapy.ConclusionScreening and management of children with FD is effective based on a defined screening protocol and a multidisciplinary approach. We should pay more attention to the high-risk profiles of pain, angiokeratoma, decreased sweating, and unexplained chronic kidney disease in children.
Highlights
Fabry disease (FD) remains poorly recognized, especially in children in China
dried blood spot (DBS) triple‐test screening for high‐risk children Before the establishment of the multidisciplinary team (MDT), no case was diagnosed with FD in the hospital
Five children were diagnosed with Fabry disease by DBS triple-test screening, with a yield of diagnosis of
Summary
Fabry disease (FD) remains poorly recognized, especially in children in China. Considering the diversity and nonspecific clinical manifestations accompanying with life-threatening aspect of this disease, methods to improve effective screening and management of the suspects are needed. Fabry disease (OMIM 301,500, FD) is an X-linked lysosomal storage disorder (LSD) caused by mutations in the GLA gene leading to deficient α-galactosidase A (α-Gal A) activity. This enzyme deficiency results in an accumulation of globotriaosylceramide (GL-3) and globotriaosylsphingosine (deacylated form of GL-3, lyso-GL-3) [1]. Other manifestations of FD, such as renal and cardiac disease, manifest later in adolescence or adulthood [2]. Newborn screening identified a surprisingly high frequency of males with FD (~ 1 in 1,250) [3]
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