Fabry's Disease: The Utility of a Multidisciplinary Screening Approach

Background: As a lysosomal storage disorder, Fabry's disease (FD) shows variable clinical manifestations. We applied our multidisciplinary approach to identify any organ damage in a sample of adult patients with different pathogenic variants. Methods: 49 participants (mean age 44.3 14.2 years; 37 females), underwent a multidimensional clinical and instrumental assessment. Results: At diagnosis, mean enzymatic activity was 5.2 4.6 nM/mL/h in females and 1.4 0.5 nM/mL/h in males (normal values > 3.0), whereas globotriaosylsphingosine was 2.3 2.1 nM/L in females and 28.7 3.5 nM/L in males (normal values < 2.0). Overall, cardiovascular, neurological, and audiological systems were the most involved, regardless of the variant detected. Patients with classic variants (10) showed typical multiorgan involvement and, in some cases, prevalent organ damage (cardiovascular, neurological, renal, and ocular). Those with late-onset variants (39) exhibited lower occurrence of multiorgan impairment, although some of them affected the cardiovascular and neurological systems more. In patients with lower enzymatic activity, the most frequent involvement was neurological, followed by peripheral vascular disease. Conclusions: FD patients exhibited wide phenotypic variability, even at single-organ level, likely due to the individual genetic mutation, although other factors may contribute. Compared to the conventional management, a multidisciplinary approach, as that prompted at our Center, allows one to achieve early clinical detection and management.