Cinética da enzima alfa-galactosidase a e investigação de doença de fabry em pacientes hemodialisados

Abstract

Human alpha-galactosidase A (α-Gal A) is a lysosomal enzyme which is deficient in Fabry disease. Fabry disease is a sphingolipidosis which chronic kidney failure (CKF) is the most important cause of morbidity and mortality. The aim of this study was the establishment of a laboratorial protocol that allows the diagnosis of Fabry’s disease in plasma and leukocytes, the analysis of α-Gal A kinetic features in plasma and searching for potential Fabry patients in 25 individual with unknown CKF. Reproducibility and fluorescence stability of the enzymatic method were also evaluated. The assay standardization was realized with the fluorescent substrate 4- methylumbeliferil-α-D-galactopyranoside. Reproducibility was evaluated using plasma samples stored at a 4ºC, -20ºC and -70ºC, the assay was performed once a month until 6 months and fluorescence stability was evaluated until 24 hours after the end of the assay. The standardization allowed the establishment of value references to α-Gal A in Pará State, from 4 to 28 nmoles/h/mL (plasma) and 20 to 96 nmoles/h/mg protein (leukocytes). α-Gal A enzyme was thermolabile and 1 minute of preincubation at 60ºC was sufficient to decrease 71.09% of its entire activity. The activity of the α-Gal A enzyme increased progressively according to incubation time, between 15 and 180 minutes. Its activity was better at pH 4,8, the Km value for the α-Gal A enzyme was 1.007 mM, and maximum reaction velocity was 30.9 nmoles/h/mL. The best storage temperature for plasma samples was -20ºC that showed less variation until 6 months. The enzyme method is stable and even after 24 hours, at room temperature, the fluorescence remained the same. All CKF patients with unknown cause presented α-Gal A activity between normal values, therefore neither was diagnosed with Fabry disease. Understanding the kinetics of the α-Gal A enzyme and its in vitro behavior will contribute to improvements in the laboratory diagnosis of Fabry disease, and provide a diagnostic baseline for the analysis of individuals affected by mutations in this enzyme.