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In Vitro Enzyme Measurement to Test Pharmacological Chaperone Responsiveness in Fabry and Pompe Disease
Published on: December 20, 2017
Baseline characteristics of patients enrolled in the Canadian Fabry Disease Initiative
S Sirrs1, J T R Clarke, D G Bichet
1Department of Medicine, University of British Columbia, Vancouver, BC, Canada. sandra.sirrs@vch.ca
Insights
The Canadian Fabry Disease Initiative (CFDI) is a national study tracking Fabry disease (FD) patients. It gathers data on disease progression and compares enzyme replacement therapies (ERT) to improve patient outcomes.
Area of Science:
- Rare genetic diseases
- Clinical research
- Pharmacology
Background:
- Fabry disease (FD) is a rare genetic disorder.
- Enzyme replacement therapy (ERT) is a primary treatment.
- Longitudinal data on FD natural history and ERT efficacy is limited.
Purpose of the Study:
- To establish a comprehensive Canadian registry for Fabry disease.
- To evaluate the natural history of FD in patients not receiving ERT.
- To compare the efficacy of two ERT formulations (agalsidase alfa and agalsidase beta).
Main Methods:
- The Canadian Fabry Disease Initiative (CFDI) is a longitudinal study with three cohorts.
- Cohort 1A: Patients on ERT before October 2006.
- Cohort 1B: Newly enrolled patients randomized to agalsidase alfa or beta.
- Cohort 1C: Patients not meeting ERT criteria, followed for natural history.
- Ongoing enrollment in Cohorts 1B and 1C.
Main Results:
- The CFDI currently includes 244 patients (95 males, 149 females) with a mean age of 41.9 years.
- High prevalence of the c.427G>C mutation observed.
- Cohort 1A: 42% cardiac and 38% renal complications.
- Cohort 1B indications: 55% cardiac, 60% renal.
- Cohort 1C comprises 125 patients, predominantly female (103).
- CFDI subjects show less male bias compared to other registries, suggesting reduced ascertainment bias.
Conclusions:
- The CFDI provides a robust national dataset on Fabry disease.
- It will enhance understanding of FD's natural history.
- The study will contribute valuable data on the comparative efficacy of available ERT products.
Abstract:
The Canadian Fabry Disease Initiative [CFDI] is a longitudinal study evaluating all Canadians diagnosed with Fabry disease [FD]. The study has 3 cohorts: Cohort 1A which includes 81 subjects who were on enzyme replacement therapy [ERT] prior to October 2006, Cohort 1B which has ongoing enrolment of subjects newly started on ERT who are randomized to agalsidase alfa or agalsidase beta, and Cohort 1C where subjects who do not meet nationally accepted Canadian criteria for ERT are followed to assess the natural history of disease complications. The study currently enrols 244 patients [95 males and 149 females] with a mean age of 41.9+/-14.5years. There is a high prevalence of the c.427G>C mutation. Cohort 1A contains 82 patients [59 males, 23 females] of whom 42% are known to have cardiac complications of FD and 38% renal complications. Cohort 1B at the time of writing contained 37 patients [15 males, 22 females] of whom the indications for ERT were cardiac in 55% and renal in 60%. Cohort 1C at the time of writing contained 125 patients [22 males, 103 females]. Enrolment is ongoing in both Cohorts 1B and 1C. When compared to subjects in the Fabry Outcome Survey and the Fabry Registry, subjects in the CFDI are less likely to be male reflecting less ascertainment bias. The CFDI is a robust national data set that will contribute to available data on the natural history of FD and on the comparative efficacy of the two commercially available ERT products.
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