Lysosomal storage disorders affecting the heart: a review

Cardiovasc Pathol. 2019 Mar-Apr:39:12-24. doi: 10.1016/j.carpath.2018.11.002. Epub 2018 Dec 1.

Abstract

Lysosomal storage disorders (LSD) comprise a group of diseases caused by a deficiency of lysosomal enzymes, membrane transporters or other proteins involved in lysosomal biology. Lysosomal storage disorders result from an accumulation of specific substrates, due to the inability to break them down. The diseases are classified according to the type of material that is accumulated; for example, lipid storage disorders, mucopolysaccharidoses and glycoproteinoses. Cardiac disease is particularly important in lysosomal glycogen storage diseases (Pompe and Danon disease), mucopolysaccharidoses and in glycosphingolipidoses (Anderson-Fabry disease). Various disease manifestations may be observed including hypertrophic and dilated cardiomyopathy, coronary artery disease and valvular diseases. Endomyocardial biopsies can play an important role in the diagnosis of these diseases. Microscopic features along with ancillary tests like special stains and ultrastructural studies help in the diagnosis of these disorders. Diagnosis is further confirmed based upon enzymatic and molecular genetic analysis. Emerging evidence suggests that Enzyme replacement therapy (ERT) substantially improves many of the features of the disease, including some aspects of cardiac involvement. The identification of these disorders is important due to the availability of ERT, the need for family screening, as well as appropriate patient management and counseling.

Keywords: Fabry Disease; Lysosomal storage disorders; Mucopolysaccharidosis; Pompe Disease.

Publication types

  • Review

MeSH terms

  • Biopsy
  • Enzyme Replacement Therapy
  • Genetic Predisposition to Disease
  • Heart Diseases / drug therapy
  • Heart Diseases / enzymology
  • Heart Diseases / genetics
  • Heart Diseases / pathology*
  • Humans
  • Lysosomal Storage Diseases / drug therapy
  • Lysosomal Storage Diseases / enzymology
  • Lysosomal Storage Diseases / genetics
  • Lysosomal Storage Diseases / pathology*
  • Myocardium / pathology*
  • Myocardium / ultrastructure
  • Phenotype
  • Risk Factors
  • Treatment Outcome