Fabry disease is an X-linked lysosomal disease, and recent newborn screening reveals a US incidence that approaches 1:3000. Beginning in childhood, patients experience significant neuropathic pain, which includes acroparesthesia (i.e., extremity tingling/burning) and episodic crises (i.e., agonizing pain lasting minutes to days). The molecular defect of Fabry disease is deficiency of the lysosomal enzyme, α-galactosidase A. When this enzyme is deficient, glycosphingolipid substrates, such as globotriaosylceramide (Gb3), accumulate in lysosomes of several cell types, including dorsal root ganglia (DRG) neurons. The neuronal glycosphingolipid accumulation likely initiates pathogenesis, but the cellular mechanisms that drive or maintain the pain development in Fabry disease are unknown. We generated a knockout (KO) rat model using CRISPR/Cas9 technology. Behavioral assays were used to longitudinally assess mechanosensation, and KO males and females were found to have increased sensitivity to noxious sharp force and decreased mechanical thresholds compared to wild type (WT) rats. In contrast, no differences in cold or heat sensitivity were detected. DRG sections show numerous inclusions and dramatically greater isolectin B4 staining in KO compared to WT neurons. These inclusions are observed primarily in smaller diameter neurons, while large diameter neurons are spared. Ultrastructural examination via electron microscopy demonstrates that the inclusions resemble “zebra-bodies,” which are characteristic in Fabry disease. Mass spectrometry reveals that compared to WT controls, Gb3 is elevated 127-fold in KO DRG. During whole cell patch clamping with focal mechanical stimulation, KO sensory neurons exhibit larger mechanically gated currents than WT. The behavioral, cellular, and molecular findings indicate that Fabry rats recapitulate pain phenotypes observed in patients, and thus this is an excellent model to study pain mechanisms and test therapies. Supported by NIH grants F30DK113641, P41GM103490, R21AI129873, R21NS095627, R24HL114474, T32GM080202.
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