Elevated Lyso-Gb3 Suggests the R118C GLA Mutation Is a Pathological Fabry Variant

  • Andrew TalbotEmail author
  • Kathy Nicholls
Research Report
Part of the JIMD Reports book series (JIMD, volume 45)


Background: Fabry disease (FD), an X-linked lysosomal storage disease, results from an α-galactosidase A deficiency and altered sphingolipid metabolism. An accumulation of globotriaosylsphingosine (lyso-Gb3) likely triggers the pathological cascade leading to disease phenotype. The pathogenic significance of several Fabry mutations including the R118C α-galactosidase (GLA) gene variant has been disputed. We describe three members of the same family with the R118C variant, each having documented clinical signs of FD, low residual enzyme levels, and an elevated lyso-Gb3 in one heterozygote.

Determining the clinical significance of each GLA gene variant remains an ongoing challenge, with potential for inadequate treatment if the diagnosis of FD is missed. Elevated lyso-Gb3 has been shown to be the most reliable noninvasive marker of clinically relevant GLA variants. While the R118C variant will likely lead to a milder phenotype, additional genetic, epigenetic, and environmental factors can ameliorate or exacerbate the expression and impact on the resultant phenotype and associated complications. Patients affected with this variant warrant closer review and better management of disease risk factors.


Fabry disease Lyso-Gb3 Pathological variant 



Alpha-galactosidase A


Fabry disease




Gene encoding α-galactosidase

Lyso Gb3




The authors thank Elizabeth Centra and Donna North for sample preparation and testing of all Fabry patients.


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Copyright information

© Society for the Study of Inborn Errors of Metabolism (SSIEM) 2018

Authors and Affiliations

  1. 1.Department of NephrologyRoyal Melbourne HospitalParkvilleAustralia
  2. 2.Department of MedicineUniversity of MelbourneParkvilleAustralia

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