Modeling Fabry nephropathy: insights from experimental systems towards precision nephrology

Fabry nephropathy is a major cause of kidney failure in Fabry disease, caused by pathogenic GLA variants that reduce α-galactosidase A activity and lead to globotriaosylceramide (Gb3) accumulation. In recent years, rapid advances in experimental modeling and emerging therapeutic strategies have dramatically reshaped understanding and treatment prospects for Fabry nephropathy. Experimental models - including cellular systems, patient-derived kidney organoids, and animal models such as zebrafish, Drosophila, mice and rats - have been pivotal in elucidating classic Gb3-dependent and novel Gb3-independent pathogenic mechanisms. These insights challenge the traditional Gb3-centric paradigm by highlighting other contributors, such as its metabolite lyso-Gb3, as well as α-synuclein accumulation and endothelial dysfunction. Despite established therapies for Fabry nephropathy, such as enzyme replacement and pharmacological chaperones, disease progression remains a clinical challenge, underscoring the urgent need for deeper mechanistic understanding and precision medicine approaches. This timely Review summarizes diverse model systems' unique strengths, limitations and translational potential to guide future research and therapeutic development for this complex disease.