biomolecules Review Fabry Disease: Molecular Basis, Pathophysiology, Diagnostics and Potential Therapeutic Directions Ken Kok 1 , Kimberley C. Zwiers 1 , Rolf G. Boot 1 , Hermen S. Overkleeft 2, Johannes M. F. G. Aerts 1,* and Marta Artola 1,* 1 Department of Medical Biochemistry, Leiden Institute of Chemistry, Leiden University, P.O. Box 9502, 2300 RA Leiden, The Netherlands;
[email protected] (K.K.);
[email protected] (K.C.Z.);
[email protected] (R.G.B.) 2 Department of Bio-organic Synthesis, Leiden Institute of Chemistry, Leiden University, P.O. Box 9502, 2300 RA Leiden, The Netherlands;
[email protected] * Correspondence:
[email protected] (J.M.F.G.A.);
[email protected] (M.A.) Abstract: Fabry disease (FD) is a lysosomal storage disorder (LSD) characterized by the deficiency of α-galactosidase A (α-GalA) and the consequent accumulation of toxic metabolites such as globotriao- sylceramide (Gb3) and globotriaosylsphingosine (lysoGb3). Early diagnosis and appropriate timely treatment of FD patients are crucial to prevent tissue damage and organ failure which no treatment can reverse. LSDs might profit from four main therapeutic strategies, but hitherto there is no cure. Among the therapeutic possibilities are intravenous administered enzyme replacement therapy (ERT), oral pharmacological chaperone therapy (PCT) or enzyme stabilizers, substrate reduction therapy (SRT) and the more recent gene/RNA therapy. Unfortunately, FD patients can only benefit from ERT and, since 2016, PCT, both always combined with supportive adjunctive and preventive therapies to clinically manage FD-related chronic renal, cardiac and neurological complications.