패브리병(Fabry) 진단을 위한 혈장 중 Globotriaosylceramide (Gb3)의 탠덤매스 분석법 개발과 임상 응용

윤혜란(Hye-Ran Yoon),조경희(Kyunghee Cho),유한욱(Han-Wook Yoo),최진호(Jin-Ho Choi),이동환(Dong Hwan Lee),Kate Zhang, Joan Keutzer 대한의학유전학회 2007 대한의학유전학회지 Vol.4 No.1

목적: 패브리병은 X-linked 지질 축적 질환으로 α-galactosidase A (α-Gal A)의 결손으로 인해 스핑고당지질인 Gb3의 세포내 축적을 일으키는 병이다. 혈장 중 Gb3 측정은 패브리병 환자의 효소대체요법 후의 모니터링이나 진단에 임상적 의의가 크므로 ESI-MS/MS를 이용한 시료 전처리를 위한 노동력이 덜 들면서 간단, 신속, 고감도로 정량할 수 있는 혈장 중 Gb3분석법을 개발하고자 하였다. 방법 : 혈장을 디옥산으로 50배 희석하여 vortex-mix 및 원심분리를 거쳐 Gb3의 추출 및 분리를 수행한다. 이 때 내부표준액인 C17:0 Gb3를 혈장에 처음부터 첨가한다. 희석과 원심분리된 혈장은 가드컬럼을 통하여 ESI-MS/MS의 다중성분 모니터링 모드에서 분석하여 내부표준액에 대한 8종 Gb3 isoform의 피크면적비를 이용하여 정량한다. 결과 : 혈장의 바탕성분 하에서 8종의 Gb3 isoform이 완전히 잘 분리됨을 확인할 수 있었다. 혈장 중의 8종의 Gb3 isoform 중 50% 이상 차지하는 종류는 C16:0 Gb3 임이 확인되었다. Gb3 isoform이 직선성을 이루는 농도 범위는 0.001-1.0 ㎍/mL이었다. 검출한계(S/N=3)는 C16:0 Gb3의 경우 0.001 ㎍/mL 이었고 정량한계는 0.01 ㎍/mL 이었으며 회수율의 일내재현성(정확도 87-108%와 정밀도 7% 이하)과 일간재현성(정확도 87-110%와 정밀도 13% 이하)은 매우 양호하였다. 결론 : 본 연구에서 개발된 Gb3 분석법은 신속, 정확, 간편하게 패브리병의 1차 스크리닝이나 효소대체요법 전후의 모니터링 및 진단에 유용하게 적용될 수 있을것이다. Purpose : A simple, rapid, and highly sensitive analytical method for Gb3 in plasma was developed without labor-extensive pre-treatment by electrospray ionization M S/M S (ESI-M S/M S). Measurement of globotriaosylceramide (Gb3, ceramide trihexoside) in plasma has clinical importance for monitoring after enzyme replacement therapy in Fabry disease patients. The disease is an X-linked lipid storage disorder that results from a deficiency of the enzyme α-galactosidase A (α-Gal A). The lack of α-Gal A causes an intracellular accumulation of glycosphingolipids, mainly Gb3. Methods : Only simple 50-fold dilution of plasma is necessary for the extraction and isolation of Gb3 in plasma. Gb3 in diluted plasma was dissolved in dioxane containing C17:0 Gb3 as an internal standard. After centrifugation it was directly injected and analyzed through guard column by in combination with multiple reaction monitoring mode of ESI-M S/M S. Results : Eight isoforms of Gb3 were completely resolved from plasma matrix. C16:0 Gb3 occupied 50 % of total Gb3 as a major component in plasma. Linear relationship for Gb3 isoforms was found in the range of 0.001-1.0 ㎍/mL. The limit of detection (S/N=3) was 0.001 ㎍/mL and limit of quantification was 0.01 ㎍/mL for C16:0 Gb3 with acceptable precision and accuracy. Correlation coefficient of calibration curves for 8 Gb3 isoforms ranged from 0.9678 to 0.9982. Conclusion : This quantitative method developed could be useful for rapid and sensitive 1st line Fabry disease screening, monitoring and/or diagnostic tool for Fabry disease.

ESI-MS/MS를 이용한 소변 중 Globotriaosylceramide(Gb3)의 정량 및 임상 응용; 패브리병(Fabry) 진단

윤혜란,조경희,강승우,권영주,정춘식,이용수,Yoon, Hye-Ran,Cho, Kyung-Hee,Kang, Seung-Woo,Kwon, Young-Joo,Jeong, Choon-Sik,Lee, Yong-Soo 대한약학회 2007 약학회지 Vol.51 No.2

Measurement of globotriaosylceramide (Gb3, ceramide trihexoside) in urine has clinical importance for monitoring after enzyme replacement therapy in Fabry disease patients. The disease is an X-linked lipid storage disorder that results from a deficiency of the enzyme ${\alpha}$-galactosidase A (${\alpha}$-Gal A). The lack of ${\alpha}$-Gal A causes an intracellular accumulation of glycosphingolipids, mainly Gb3. A simple, rapid, and highly sensitive analytical method for Gb3 in urine was developed without labor-extensive pre-treatment by electrospray ionization MS/MS (ESI-MS/MS). Only simple 5-fold dilution of urine is necessary for the extraction and isolation of Gb3 in urine. Gb3 in diluted urine was dissolved in dioxane containing C17:0 Gb3 as an internal standard. After centrifugation it was directly injected and analyzed through guard column by in combination with multiple reaction monitoring mode of ESI-MS/MS. Eight isoforms of Gb3 were completely resolved from urine matrix. C24:0 Gb3 occupied 50% of total Gb3 as a major component in urine. Linear relationship for Gb3 isoforms was found in the range of 0.005${\sim}$5.0 ${\mu}$g/ml. The limit of detection (S/N=5) was 0.005 ${\mu}$g/ml and limit of quantification was 0.05 ${\mu}$g/ml for C24:0 Gb3 with acceptable precision and accuracy. Correlation coefficient of calibration curves for 8 Gb3 isoforms ranged from 0.9598 to 0.9975. This method could be useful for rapid and sensitive 1st line Fabry disease screening, monitoring and/or diagnostic tool for Fabry disease.

Serum Globotriaosylceramide Assay as a Screening Test for Fabry Disease in Patients with ESRD on Maintenance Dialysis in Korea

( Jeong-Yup Kim ),( Young-Youl Hyun ),( Ji-Eun Lee ),( Hye-Ran Yoon ),( Gu-Hwan Kim ),( Han-Wook Yoo ),( Seong-Tae Cho ),( No-Won Chun ),( Byoung-Chunn Jeoung ),( Hwa-Jung Kim ),( Keong-Wook Kim ),( S 대한내과학회 2010 The Korean Journal of Internal Medicine Vol.25 No.4

Background/Aims: Fabry disease is an X-linked recessive and progressive disease caused by α-galactosidase A (α-GaL A) deficiency. We sought to assess the prevalence of unrecognized Fabry disease in dialysis-dependent patients and the efficacy of serum globotriaosylceramide (GL3) screening. Methods: A total of 480 patients of 1,230 patients among 17 clinics were enrolled. Serum GL3 levels were measured by tandem mass spectrometry. Additionally, we studied the association between increased GL3 levels and cardiovascular disease, cerebrovascular disease, or left ventricular hypertrophy. Results: Twenty-nine patients had elevated serum GL3 levels. The α-GaL A activity was determined for the 26 patients with high GL3 levels. The mean α-GaL A activity was 64.6 nmol/hr/mg (reference range, 45 to 85), and no patient was identified with decreased α-GaL A activity. Among the group with high GL3 levels, 15 women had a α-GaL A genetics analysis. No point mutations were discovered among the women with high GL3 levels. No correlation was observed between serum GL3 levels and α-GaL A activity; the Pearson correlation coefficient was 0.01352 (p = 0.9478). No significant correlation was observed between increased GL3 levels and the frequency of cardiovascular disease or cerebrovascular disease. Conclusions: Fabry disease is very rare disease in patients with end-stage renal disease. Serum GL3 measurements as a screening method for Fabry disease showed a high false-positive rate. Thus, serum GL3 levels determined by tandem mass spectrometry may not be useful as a screening method for Fabry disease in patients with end stage renal disease. (Korean J Intern Med 2010;25:415-421)

패브리병(Fabry) 진단을 위한 혈장 중 Globotriaosylceramide (Gb3)의 탠덤매스 분석법 개발과 임상 응용

Yoon, Hye-Ran,Cho, Kyung-Hee,Yoo, Han-Wook,Choi, Jin-Ho,Lee, Dong-Hwan,Zhang, Kate,Keutzer, Joan 대한의학유전학회 2007 대한의학유전학회지 Vol.4 No.1

목 적 : 패브리병은 X-linked 지질 축적 질환으로 ${\alpha}$-galactosidase A (${\alpha}$-Gal A)의 결손으로 인해 스핑고당지질인 Gb3의 세포내 축적을 일으키는 병이다. 혈장 중 Gb3 측정은 패브리병 환자의 효소대체요법 후의 모니터링이나 진단에 임상적 의의가 크므로 ESI-MS/MS를 이용한 시료 전처리를 위한 노동력이 덜 들면서 간단, 신속, 고감도로 정량할 수 있는 혈장 중 Gb3분석법을 개발하고자 하였다. 방 법 : 혈장을 디옥산으로 50배 희석하여 vortex-mix 및 원심분리를 거쳐 Gb3의 추출 및 분리를 수행한다. 이 때 내부표준액인 C17:0 Gb3를 혈장에 처음부터 첨가한다. 희석과 원심분리된 혈장은 가드컬럼을 통하여 ESI-MS/MS의 다중성분 모니터링 모드에서 분석하여 내부표준액에 대한 8종 Gb3 isoform의 피크면적비를 이용하여 정량한다. 결 과 : 혈장의 바탕성분 하에서 8종의 Gb3 isoform이 완전히 잘 분리됨을 확인할 수 있었다. 혈장 중의 8종의 Gb3 isoform 중 50% 이상 차지하는 종류는 C16:0 Gb3 임이 확인되었다. Gb3 isoform이 직선성을 이루는 농도 범위는 0.001-1.0 ${\mu}g$/mL이었다. 검출한계(S/N=3)는 C16:0 Gb3의 경우 0.001 ${\mu}g$/mL 이었고 정량한계는 0.01 ${\mu}g$/mL 이었으며 회수율의 일내재현성(정확도 87-108%와 정밀도 7% 이하)과 일간재현성(정확도 87-110%와 정밀도 13% 이하)은 매우 양호 하였다. 결 론 : 본 연구에서 개발된 Gb3 분석법은 신속, 정확, 간편하게 패브리병의 1차 스크리닝이나 효소대체요법 전후의 모니터링 및 진단에 유용하게 적용될 수 있을 것이다. Purpose : A simple, rapid, and highly sensitive analytical method for Gb3 in plasma was developed without labor-ex tensive pre-treatment by electrospray ionization MS/ MS (ESI-MS/MS). Measurement of globotriaosy lceramide (Gb3, ceramide trihex oside) in plasma has clinical importance for monitoring after enzyme replacement therapy in Fabry disease patients. The disease is an X-linked lipid storage disorder that results from a deficiency of the enzyme ${\alpha}$-galactosidase A (${\alpha}$-Gal A). The lack of ${\alpha}$-Gal A causes an intracellular accumulation of glycosphingolipids, mainly Gb3. Methods : Only simple 50-fold dilution of plasma is necessary for the extraction and isolation of Gb3 in plasma. Gb3 in diluted plasma was dissolved in dioxane containing C17:0 Gb3 as an internal standard. After centrifugation it was directly injected and analyzed through guard column by in combination with multiple reaction monitoring mode of ESI-MS/MS. Results : Eight isoforms of Gb3 were completely resolved from plasma matrix. C16:0 Gb3 occupied 50% of total Gb3 as a major component in plasma. Linear relationship for Gb3 isoforms w as found in the range of 0.001-1.0 ${\mu}g$/mL. The limit of detection (S/N=3) was 0.001 ${\mu}g$/mL and limit of quantification was 0.01 ${\mu}g$/mL for C16:0 Gb3 with acceptable precision and accuracy. Correlation coefficient of calibration curves for 8 Gb3 isoforms ranged from 0.9678 to 0.9982. Conclusion : This quantitative method developed could be useful for rapid and sensitive 1st line Fabry disease screening, monitoring and/or diagnostic tool for Fabry disease.

Evaluation of the urinary globotriaosylceramide (Gb3) assay by tandem mass spectrometry

Song, Min-Jung,Ji, Ok-Ja,Park, Hyung-Doo,Jin, Dong-Kyu,Lee, Soo-Youn The Korean Society of Toxicogenomics and Toxicopro 2010 Molecular & cellular toxicology Vol.6 No.2

Fabry disease (FD) is an X-linked lysosomal storage disorder resulting from a deficiency of $\alpha$-galactosidase A, which leads to the progressive accumulation of one biomarker, globotriaosylceramide (Gb3), prominently elevated in the urine of affected patients. Using filter paper discs saturated with urine, we evaluated the analytical performance and clinical usefulness of the urinary Gb3 assay by tandem mass spectrometry (LC-MS/MS), with respect to linearity, precision, and reproducibility. We used healthy control urine samples to validate the reference interval of urinary Gb3. This method showed a good linearity ($R^2=0.9998$) in the range of $0.05-10\;{\mu}g/mL$. Within-run CVs were less than 5% and total CVs were within 10%. The mean recovery of Gb3 from the urine filter paper was 96.7% and the limit of quantification (S/N $\geq$ 5) was $0.05\;{\mu}g/mL$, which was sensitive enough for the diagnosis of FD. The mean concentration of Gb3 in urine samples from healthy Korean controls was $5.93{\pm}3.6\;{\mu}g/mmol$ Cr (range $0.9-16.43\;{\mu}g/mmol$ Cr). The urinary Gb3 assay by LC-MS/MS showed good analytical performance required for the diagnosis of FD in its linearity, precision, and accuracy. Therefore, this technique could be used for a rapid and reliable first line screening, monitoring and/or diagnosis of individuals at high risk for FD.

Substrate-specific gene expression profiles in different kidney cell types are associated with Fabry disease

SHIN, YOUN-JEONG,JEON, YEO JIN,JUNG, NAMHEE,PARK, JOO-WON,PARK, HAE-YOUNG,JUNG, SUNG-CHUL SPANDIDOS PUBLICATIONS 2015 MOLECULAR MEDICINE REPORTS Vol.12 No.4

<P>Fabry disease is an X-linked lysosomal storage disorder caused by mutations in the gene encoding the α-galactosidase A (α-Gal A) lysosomal enzyme, which results in globotriaosylceramide (Gb3) storage in vascular endothelial cells and different cell types throughout the body. Involvement of the of Fabry disease. An increased concentration of deacylated Gb3 (lyso-Gb3) in the plasma of symptomatic patients has also been suggested as a causative molecular event. To elucidate the molecular mechanisms involved in renal fibrosis in Fabry disease, the present analyzed the changes in global gene expression prior to and following Gb3 or lyso-Gb3 treatment in two types of kidney cell lines, human proximal renal tubular epithelial (HK-2) and mouse renal glomerular mesangial (SV40 MES 13) cells. Gb3 and lyso-Gb3 treatment regulated the expression of 199 and 328 genes in each cell type, demonstrating a >2.0-fold change. The majority of the biological functions of the regulated genes were associated with fibrogenesis or epithelial-mesenchymal transition (EMT). The gene expression patterns of sphingolipid-treated HK-2 cells were distinguishable from the patterns in the SV40 MES 13 cells. Several genes associated with the EMT were selected and evaluated further in kidney cells and in Fabry mouse kidney tissues. In the SV40 MES 13 cells, the <I>DLL1</I>, <I>F8</I>, and <I>HOXA11</I> genes were downregulated, and <I>FOXP2</I> was upregulated by treatment with Gb3 or lyso-Gb3. In the HK-2 cells, the <I>ADAMTS6</I>, <I>BEST1</I>, <I>IL4</I>, and <I>MYH11</I> genes were upregulated. Upregulation of the <I>FOXP2</I>, <I>COL15A1</I>, <I>IL4</I>, and <I>MYH11</I> genes was also observed in the Fabry mouse kidney tissues. The gene expression profiles in kidney cells following the addition of Gb3 or lyso-Gb3 revealed substrate-specific and cell-specific patterns. These findings suggested that Gb3 and lyso-Gb3 lead to renal fibrosis in Fabry disease through different biochemical modulations.</P>

탠덤매스에의한 체액 중 Globotriaocylceramide(Gb-3)의 측정을 이용한 한국인 고 위험도군에서의 파브리병 스크리닝

윤혜란(Hye-Ran Yoon) 대한약학회 2011 약학회지 Vol.55 No.1

Fabry disease (FD) is an X-linked inborn error of glycoshpingolipid metabolism resulting from mutation in the enzyme α-galactosidase A gene. The disease is an X-linked lipid storage disorder and the lack of α-Gal A causes an intracellular accumulation of glycosphingolipids, mainly globotriaosylceramide (Gb-3). Measurement of Gb-3 in plasma has clinical importance for monitoring after enzyme replacement therapy for confirmed FD patients. Using electrospray ionization MS/MS we had developed, a simple, rapid, and highly sensitive analytical method for Gb-3 in plasma was used for the purpose of screening FD among high risk groups in Korean population. To date, no comprehensive results for FD screening have been performed and reported in Korea. We screened 1,100 outpatients from 13 hospitals (including clinics) to assess the incidence of FD among patients in high risk groups. For patients with borderline level amount of Gb-3, we repeated Gb-3 or performing complementary or confirmative assay with α-Gal A activity and DNA mutaion analysis for confirmation diagnosis. Of 1,100 we diagnosed 3 FD with 2 classical type and 1 carrier (0.27%).

Short-Term Efficacy of Enzyme Replacement Therapy in Korean Patients with Fabry Disease

Choi, Jin-Ho,Cho, Young Mi,Suh, Kwang-Sun,Yoon, Hye-Ran,Kim, Gu-Hwan,Kim, Sung-Su,Ko, Jung Min,Lee, Joo Hoon,Park, Young Seo,Yoo, Han-Wook The Korean Academy of Medical Sciences 2008 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.23 No.2

<P>Fabrazyme has been widely used for treatment of Fabry disease since its approval by the U.S. Food and Drug Administration in 2003. This study was undertaken to assess the short-term efficacy and safety of enzyme replacement therapy (ERT) for Fabry disease in Korea. Eight male patients and three female symptomatic carriers aged 13 to 48 yr were included. Fabrazyme was administered by intravenous infusion at a dose of 1 mg/kg every 2 weeks. Plasma and urine globotriaosylceramide (GL-3) levels, serum creatinine, creatinine clearance, and 24-hr urine protein levels were measured every 3 months. Kidney biopsies, ophthalmologic exams, and pure tone audiometry were performed before and 1 yr after ERT. Kidney function, including serum creatinine, creatinine clearance, and the 24-hr urine protein level, remained stable during ERT. Plasma and urine GL-3 levels were reduced within 3 to 6 months of ERT initiation. Microvascular endothelial deposits of GL-3 were decreased from renal biopsy specimens after 1 yr of treatment. The severity of sensorineural hearing loss and tinnitus did not improve after ERT. ERT is safe and effective in stabilizing renal function and clearing microvascular endothelial GL-3 from kidney biopsy specimen in Korean patients with Fabry disease.</P>

Fabry nephropathy before and after enzyme replacement therapy: important role of renal biopsy in patients with Fabry disease

( Il Young Kim ),( Hyun Jung Lee ),( Chong Kun Cheon ) 대한신장학회 2021 Kidney Research and Clinical Practice Vol.40 No.4

Background: In Fabry disease, the presence of globotriaosylceramide (GL3) deposits in various kidney cells leads to progressive renal dysfunction. However, kidney biopsy studies in patients with Fabry disease are limited. In the present study, the pathologic findings of patients with Fabry nephropathy receiving enzyme replacement therapy (ERT) and untreated patients without albuminuria were investigated. Methods: The present study included 15 patients with Fabry disease who underwent renal biopsy while receiving ERT (group 1: n = 9, age 19-58 years, two males and seven females) or before ERT initiation (group 2: n = 6, age 11-66 years, one male and five females). All patients in group 2 were normoalbuminuric. Results: Group 1 showed improved clinical symptoms, such as acroparesthesia. The ERT duration was 1.2 to 8 years and seven of the nine patients showed GL3 deposits in various kidney cells and segmental foot process effacement (FPE) of podocytes. GL3 deposits and FPE were not observed in the two remaining patients in group 1. Group 2 showed segmental FPE and podocyte GL3 deposits. Most patients in group 2 also showed GL3 deposits in the mesangium, endothelium, or tubular epithelium. Conclusion: The study results showed that segmental FPE and GL3 deposits can persist in Fabry nephropathy despite ERT. In addition, segmental FPE and GL3 deposits were observed in various kidney cells in normoalbuminuric patients with Fabry disease. These findings indicated that kidney biopsies at baseline and follow-up evaluation of Fabry nephropathy are essential for timely ERT initiation and ERT response assessment.

Short-Term Efficacy of Enzyme Replacement Therapy in Korean Patients with Fabry Disease

최진호,조영미,서광선,윤혜란,Gu Hwan Kim,Sung Su Kim,고정민,이주훈,박영서,유한욱 대한의학회 2008 Journal of Korean medical science Vol.23 No.2

Fabrazyme has been widely used for treatment of Fabry disease since its approval by the U.S. Food and Drug Administration in 2003. This study was undertaken to assess the short-term efficacy and safety of enzyme replacement therapy (ERT) for Fabry disease in Korea. Eight male patients and three female symptomatic carriers aged 13 to 48 yr were included. Fabrazyme was administered by intravenous infusion at a dose of 1 mg/kg every 2 weeks. Plasma and urine globotriaosylceramide (GL-3) levels, serum creatinine, creatinine clearance, and 24-hr urine protein levels were measured every 3 months. Kidney biopsies, ophthalmologic exams, and pure tone audiometry were performed before and 1 yr after ERT. Kidney function, including serum creatinine, creatinine clearance, and the 24-hr urine protein level, remained stable during ERT. Plasma and urine GL-3 levels were reduced within 3 to 6 months of ERT initiation. Microvascular endothelial deposits of GL-3 were decreased from renal biopsy specimens after 1 yr of treatment. The severity of sensorineural hearing loss and tinnitus did not improve after ERT. ERT is safe and effective in stabilizing renal function and clearing microvascular endothelial GL-3 from kidney biopsy specimen in Korean patients with Fabry disease.