Autoimmune and Inflammatory Response Biomarkers in Fabry Disease

Study Overview
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Brief Summary
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The goal of this observational study is to understand the immune response in Fabry disease (FD). We want to find out how the immune response is related to the severity of FD and how it affects patients' quality of life and pain. Main Questions the Study Aims to Answer: How are immune response markers linked to the health of FD patients? How is the immune response different between FD patients and healthy individuals? Participants: We will include 20 patients who have FD and are older than 18, and do not have other autoimmune or autoinflammatory diseases. We'll also include a comparison group of the same size who don't have FD, but are similar in age and sex to the FD group. Participants with Fabry disease will be asked about their medical history and complete questionnaires. We will measure their vital signs and collect blood samples to study immune response markers. We'll also look at specific biomarkers related to FD. Healthy participants will do similar tasks for comparison. Comparison: Researchers will compare the immune response markers and other measurements between FD patients and healthy individuals to understand the differences and similarities. Duration: The study will take place over 18 months to gather comprehensive information.

Detailed Description
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Rationale: The immune response could play a relevant role in the pathophysiological mechanisms of Fabry disease (FD), although the relationship between the activated immune pathways and the clinical expression of the disease needs to be clarified. Knowledge of the immune response in FD could help to better understand the progression of the disease, identifying new biomarkers potentially useful in the clinical follow-up of these patients. Study design: Observational cross-sectional study with a control group. Study subjects: Target group: patients with Fabry disease, older than 18 years and without autoimmune or autoinflammatory diseases. Control group: subjects without Fabry disease matched for age (± 5 years) and sex. Sample size: n=40 (20 patients with Fabry disease + 20 controls). Objectives: To study the relationship between immune response biomarkers and the clinical status of the patient, as measured by the MSSI scale (Mainz Severity Score Index) or by markers of target organ damage (clinical, biochemical and imaging parameters). To characterize the immune response profile by circulating biomarkers of subjects with Fabry disease (FD) compared to healthy subjects. To compare circulating biomarker values with those measured in PBMC (Peripheral Blood Mononuclear Cells) culture supernatant from patients with FD. To evaluate the relationship between biomarkers of the immune response and the concentration of specific Fabry disease markers (Lyso-Gb3). To evaluate the association between immune response biomarkers and quality of life and neuropathic pain in FD patients. Variables: Demographics, vital signs, anthropometric data, FD medical history, questionnaires, clinical biochemical variables, biochemical markers of autoimmunity, specific markers of FD (Lyso-Gb3), immune response markers and markers of target organ damage. Duration: 18 months

Official Title
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Autoimmune and Inflammatory Response Biomarkers in Fabry Disease

Conditions
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Fabry Disease

Participation Criteria
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Eligibility Criteria
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For the Fabry Disease (FD) group: Inclusion Criteria: Age ≥ 18 years. Diagnosis of Fabry disease (enzymatic or genetic). Having signed the informed consent, after having received all the information concerning the study. Exclusion Criteria: Autoimmune or autoinflammatory disease or patients with transplanted organs (corneal transplant excluded) and under additional immunosuppressive treatment. Acute cardiovascular event or major surgery in the 90 days prior to inclusion in the study. Serious intercurrent diseases such as HIV, COVID-19, cancer under active treatment, severe anemia, severe hepatic, respiratory or renal failure, or other pathologies that, at the investigator's discretion, could interfere with the objectives of the study. For the Control group: • Participants must not meet any of the exclusion criteria applied to the target (FD) population and must sign, prior to inclusion, the informed consent form after having received all the information concerning the study.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Fabry Disease<br>Patients with Fabry disease, older than 18 years, and without autoimmune or autoinflammatory diseases. | |
| Control<br>Subjects without Fabry disease or autoimmune/autoinflammatory diseases, matched for age (± 5 years) and sex. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| High-sensitivity C-reactive protein (hsCRP) | High-sensitivity C-reactive protein (hsCRP), measured in mg/L. | Day 1 (one cross-sectional examination only) | 
| Tumor necrosis factor (TNF) | Tumor necrosis factor (TNF), measured in pg/mL. | Day 1 (one cross-sectional examination only) | 
| Interleukin 6 (IL-6) | Interleukin 6 (IL-6), measured in pg/mL. | Day 1 (one cross-sectional examination only) | 
| Interferon gamma (IFN-γ) | Interferon gamma (IFN-γ), measured in pg/mL. | Day 1 (one cross-sectional examination only) | 
| Vascular cell adhesion protein 1 (VCAM-1) | Vascular cell adhesion protein 1 (VCAM-1), measured in ng/mL. | Day 1 (one cross-sectional examination only) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Globotriaosylsphingosine (Lyso-Gb3) | The globotriaosylsphingosine (Lyso-Gb3), the deacylated derivative of Gb3, measured in plasma (ng/mL). | Day 1 (one cross-sectional examination only) | 
| Brain natriuretic peptide (BNP) | Brain natriuretic peptide (BNP), measured in pg/mL. | Day 1 (one cross-sectional examination only) | 
| N-terminal prohormone of brain natriuretic peptide (NT-proBNP) | N-terminal prohormone of brain natriuretic peptide (NT-proBNP), measured in pg/mL. | Day 1 (one cross-sectional examination only) | 
| Cystatin C | Cystatin C, measured in mg/dL. | Day 1 (one cross-sectional examination only) | 
| EuroQol Health-Related Quality of Life (EQ-5D-5L) | EQ-5D-5L is a standardised measure of health-related quality of life. The EQ-5D-5L essentially consists of a descriptive system that comprises five dimensions: mobility, self-care, usual activities, pain and discomfort, and anxiety and depression, and five levels in these dimensions, and EQ-5D visual analogue scale (EQ VAS). A numerical value will be derived for each EQ-5D-5L health state (ranges from 1 representing full health to 0 representing dead) to reflect how good or bad a health state is according to the preferences of the general population in Spain. EQ VAS ranges from 0 (the worst health you can imagine) to 100 (the best health you can imagine). | Day 1 (one cross-sectional examination only) | 
| 11-point numerical rating scale (NRS-11) score of neuropathic pain | The Numeric Pain Rating Scale is a unidimensional measure of pain intensity in adults. The 11-point numerical rating scale (NRS-11) scores neuropathic pain ranging from '0' representing no pain to '10' representing pain as bad as you can imagine. | Day 1 (one cross-sectional examination only) | 
| Mainz Severity Score Index (MSSI) | The Mainz Severity Score Index (MSSI) is an instrument for quantifying the overall severity of the signs and symptoms of Fabry disease. The MSSI assigns scores based on the presence and severity of signs and symptoms in four areas: general, neurologic, cardiovascular, and renal. Each of the signs and symptoms is weighted in accordance with its relationship to morbidity. MSSI scoring ranges from 0 (healthy) to 76 (maximum severity), and it is divided into severity bands of mild (<20), moderate (20-40), and severe (>40) affliction. | Day 1 (one cross-sectional examination only) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Fabry Disease, Immune response, Biomarkers, Quality of life, Inflammation