• Isabel De Brabander, Laetitia Yperzeele, Chantal Ceuterick-De Groote, Raf Brouns, Robert Baker, Shibeshih Belachew, Jean Delbecq, Gilles De Keulenaer, Sophie Dethy, François Eyskens, Arnaud Fumal, Dimitri Hemelsoet, Derralynn Hughes, Sandrine Jeangette, Dirk Nuytten, Patricia Redondo, Bernard Sadzot, Christian Sindic, Rishi Sheorajpanday, Vincent Thijs, Christine Van Broeckhoven, and Peter P De Deyn.
• Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium.
• Clin Neurol Neurosurg. 2013 Jul 1; 115 (7): 1088-93.

ObjectiveIn the Belgian Fabry Study (BeFaS), the prevalence of Fabry disease was assessed in 1000 young patients presenting with stroke, unexplained white matter lesions or vertebrobasilar dolichoectasia. The results of the BeFaS suggested that Fabry disease may play a role in up to 1% of young patients presenting with cerebrovascular disease. However, the clinical relevance was unclear in all cases. We report on detailed phenotyping in subjects identified with α-galactosidase A (α-Gal A) enzyme deficiency or GLA mutations identified in the BeFaS (n=10), and on the results of family screening in this population.MethodsFamily screening was performed to identify additional mutation carriers. Biochemical and/or clinical evaluation of all subjects (BeFaS index patients and relatives carrying a GLA mutation) was performed.ResultsGenetic family screening revealed 18 additional GLA mutation carriers. Bloodspot α-Gal A enzyme activity was normal in all GLA mutation carriers, even in 2 males with the p.A143T mutation. Plasma Gb3 and lyso-Gb3 levels were normal in all subjects. Elevated Gb3 in urine was detected in 2 subjects. Some classic clinical signs of Fabry disease, like angiokeratoma or cornea verticillata, could not be detected in our population. Cardiac symptoms of Fabry disease were found in 6 out of 10 p.A143T carriers. No signs of cerebrovascular disease were found in the relatives with a GLA mutation.ConclusionsWe could not identify mutations causing the classical clinical phenotype of Fabry disease in our cerebrovascular disease population. Enzyme activity analysis in bloodspots and plasma may fail to identify late-onset variants of Fabry disease. We recommend genetic testing when an atypical, late-onset variant of Fabry disease is suspected in a male cerebrovascular disease patient. However, this may lead to the identification of non-disease causing or controversial genetic variants.Copyright © 2012 Elsevier B.V. All rights reserved.

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