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Clinical Chemistry 51: 688-694, 2005. First published February 3, 2005; 10.1373/clinchem.2004.041418
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(Clinical Chemistry. 2005;51:688-694.)
© 2005 American Association for Clinical Chemistry, Inc.

Molecular Diagnostics and Genetics

Urinary Lipid Profiling for the Identification of Fabry Hemizygotes and Heterozygotes

Maria Fuller1,3,a, Peter C. Sharp2, Tina Rozaklis1, Phillip D. Whitfield1,1, David Blacklock1, John J. Hopwood1,3 and Peter J. Meikle1,3

1 Lysosomal Diseases Research Unit and 2 National Referral Laboratory, Department of Genetic Medicine, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia.
3 Department of Paediatrics, University of Adelaide, Adelaide, South Australia, Australia.

aAddress correspondence to this author at: Lysosomal Diseases Research Unit, Women’s and Children’s Hospital, 72 King William Road, North Adelaide, South Australia, 5006, Australia. Fax 61-8-8161-7100; e-mail maria.fuller{at}adelaide.edu.au.

Background: Fabry disease is an X-linked lysosomal storage disorder resulting from a deficiency of the lysosomal hydrolase, {alpha}-galactosidase, for which enzyme replacement therapy is now available. In this study, we aimed to identify Fabry heterozygotes not only for genetic counseling of families but because it is becoming increasingly obvious that many heterozygous (carrier) females are symptomatic and should be considered for treatment.

Methods: We measured 29 individual lipid species, including ceramide, glucosylceramide, lactosylceramide, and ceramide trihexoside, in urine samples from Fabry hemizygotes and heterozygotes and from control individuals by electrospray ionization tandem mass spectrometry. Individual analyte species and analyte ratios were analyzed for their ability to differentiate the control and patient groups.

Results: The Fabry hemizygotes had increased concentrations of the substrate for the deficient enzyme, ceramide trihexoside, as well as lactosylceramide and ceramide, along with decreased concentrations of both glucosylceramide and sphingomyelin. Ratios of these analytes improved differentiation between the control and Fabry groups, with the Fabry heterozygotes generally falling between the Fabry hemizygotes and the control group.

Conclusions: These lipid profiles hold particular promise for the identification of Fabry individuals, may aid in the prediction of phenotype, and are potentially useful for the monitoring of therapy in patients receiving enzyme replacement.






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