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Detailed Phenotype of GLA Variants Identified by the Nationwide Neurological Screening of Stroke Patients in the Czech Republic

P. Reková, G. Dostálová, D. Kemlink, J. Paulasová Schwabová, Z. Dubská, M. Vaneckova, M. Mašek, O. Kodet, H. Poupětová, S. Mazurová, A. Rajdova, E. Vlckova, A. Táboříková, Š. Fafejtová, M. Nevsimalova, A. Linhart, A. Tomek

. 2021 ; 10 (16) : . [pub] 20210812

Jazyk angličtina Země Švýcarsko

Typ dokumentu časopisecké články

Perzistentní odkaz   https://www.medvik.cz/link/bmc21024172

Grantová podpora
MZCZ-DRO-VFN64165 Ministerstvo Zdravotnictví Ceské Republiky

Fabry disease (FD) is a rare X-linked disorder of glycosphingolipid metabolism caused by pathogenic variants within the alpha-galactosidase A (GLA) gene, often leading to neurological manifestations including stroke. Multiple screening programs seeking GLA variants among stroke survivors lacked detailed phenotype description, making the interpretation of the detected variant's pathogenicity difficult. Here, we describe detailed clinical characteristics of GLA variant carriers identified by a nationwide stroke screening program in the Czech Republic. A total of 23 individuals with 8 different GLA variants were included in the study. A comprehensive diagnostic workup was performed by a team of FD specialists. The investigation led to the suggestion of phenotype reclassification for the G325S mutation from late-onset to classical. A novel variant R30K was found and was classified as a variant of unknown significance (VUS). The typical manifestation in our FD patients was a stroke occurring in the posterior circulation with an accompanying pathological finding in the cerebrospinal fluid. Moreover, we confirmed that cornea verticillata is typically associated with classical variants. Our findings underline the importance of detailed phenotype description and data sharing in the correct identification of pathogenicity of gene variants detected by high-risk-population screening programs.

2nd Department of Medicine Department of Cardiovascular Medicine 1st Faculty of Medicine Charles University 128 08 Prague Czech Republic

Biotechnology and Biomedicine Centre Academy of Science Charles University 252 50 Vestec Czech Republic

Department of Dermatovenerology 1st Faculty of Medicine Charles University and General University Hospital Prague 128 08 Prague Czech Republic

Department of Neurology 2nd Faculty of Medicine Charles University and Motol University Hospital Prague 150 06 Prague Czech Republic

Department of Neurology and Centre of Clinical Neuroscience 1st Faculty of Medicine Charles University and General University Hospital Prague 128 08 Prague Czech Republic

Department of Neurology and Stroke Centre Country Hospital Chomutov 430 12 Chomutov Czech Republic

Department of Neurology and Stroke Centre Hospital Karlovy Vary 360 01 Karlovy Vary Czech Republic

Department of Neurology Faculty of Medicine Masaryk University and University Hospital Brno 625 00 Brno Czech Republic

Department of Neurology Hospital Ceske Budejovice 370 01 České Budějovice Czech Republic

Department of Ophthalmology 1st Faculty of Medicine Charles University and General University Hospital Prague 128 08 Prague Czech Republic

Department of Paediatric Neurology 2nd Faculty of Medicine Charles University and Motol University Hospital Prague 150 06 Prague Czech Republic

Department of Paediatrics and Inherited Metabolic Disorders 1st Faculty of Medicine University and General University Hospital Prague 128 08 Prague Czech Republic

Department of Radiology 1st Faculty of Medicine Charles University and General University Hospital Prague 128 08 Prague Czech Republic

Institute of Anatomy 1st Faculty of Medicine Charles University Prague 128 08 Prague Czech Republic

Citace poskytuje Crossref.org

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$a Fabry disease (FD) is a rare X-linked disorder of glycosphingolipid metabolism caused by pathogenic variants within the alpha-galactosidase A (GLA) gene, often leading to neurological manifestations including stroke. Multiple screening programs seeking GLA variants among stroke survivors lacked detailed phenotype description, making the interpretation of the detected variant's pathogenicity difficult. Here, we describe detailed clinical characteristics of GLA variant carriers identified by a nationwide stroke screening program in the Czech Republic. A total of 23 individuals with 8 different GLA variants were included in the study. A comprehensive diagnostic workup was performed by a team of FD specialists. The investigation led to the suggestion of phenotype reclassification for the G325S mutation from late-onset to classical. A novel variant R30K was found and was classified as a variant of unknown significance (VUS). The typical manifestation in our FD patients was a stroke occurring in the posterior circulation with an accompanying pathological finding in the cerebrospinal fluid. Moreover, we confirmed that cornea verticillata is typically associated with classical variants. Our findings underline the importance of detailed phenotype description and data sharing in the correct identification of pathogenicity of gene variants detected by high-risk-population screening programs.
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