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Vol. 218. Issue 9.
Pages 455-504 (December 2018)
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Vol. 218. Issue 9.
Pages 455-504 (December 2018)
Review
DOI: 10.1016/j.rceng.2018.03.008
Treatment in Fabry disease
Tratamiento en la enfermedad de Fabry
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M. López Rodríguez
Grupo de Trabajo de Enfermedades Minoritarias, Sociedad Española de Medicina Interna (SEMI), Spain
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Table 1. Clinical manifestations, according to age, in Fabry disease.
Abstract

Fabry disease is an X-linked inborn disease caused by deficit of alpha-galactosidase A. This results in accumulation of glycosphingolipids in all cells and tissues. All males should receive enzyme replacement treatment in case of very low or undetectable levels of alpha-galactosidase A. Female carriers and males with marginally levels of alpha-galactosidase A should be treated in case of renal, neurologic o cardiac manifestations. There are two intravenous formulations of human recombinant enzyme, agalsidase alpha and agalsidase beta, showing similar efficacy and safety. Patients with amenable mutations of alpha-galactosidase can be treated with oral migalastat hydrochloride. Migalastat hydrochloride is a pharmacological chaperone that facilitates trafficking of alpha-galactosidase A to lysosomes increasing enzyme activity. Patients treated with migalastat hydrochloride had significant improvements in left ventricular mass and gastrointestinal symptoms.

Keywords:
Fabry disease
Multisystemic
Migalastat
Chaperone
Resumen

La enfermedad de Fabry es una enfermedad ligada al cromosoma X causada por un déficit de alfa-galactosidasa A. Esto da como resultado la acumulación de glicoesfingolípidos en todas las células y tejidos. Todos los varones deben tratarse con reemplazo enzimático en caso de presentar niveles muy bajos o indetectables de alfa-galactosidasa A. Las mujeres portadoras y los varones con niveles mínimos de alfa-galactosidasa A deben tratarse si existe afectación renal, neurológica o cardíaca. Para terapia de reemplazo enzimático existen dos formulaciones intravenosas, agalsidasa alfa y agalsidasa beta, que muestran una eficacia y seguridad similares. Los pacientes con mutaciones susceptibles del gen alfa-galactosidasa A pueden tratarse con migalastat oral. El migalastat es una molécula que facilita el paso de alfa-galactosidasa A a los lisosomas, produciendo aumento de actividad del enzima. Los pacientes tratados con migalastat muestran mejoras significativas en la masa del ventrículo izquierdo y en los síntomas gastrointestinales.

Palabras clave:
Enfermedad de Fabry
Multisistémica
Migalastat
Chaperona

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