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In Vitro Enzyme Measurement to Test Pharmacological Chaperone Responsiveness in Fabry and Pompe Disease
Published on: December 20, 2017
Pompe Disease: From a Cardiovascular Lens
Abdullah Ali1, Dinushan Thirumavalavan1, John Nicholas Catanzaro1
1From the Department of Medicine, Northwell Health, New Hyde Park, NY.
Abstract:
Pompe disease (glycogen storage disease type 2, acid maltase deficiency) is an uncommon, progressive, autosomal recessive lysosomal storage disorder caused by a lack of the enzyme acid α-glucosidase. The enzyme deficiency results in the abnormal buildup of glycogen in lysosomes, especially in skeletal, cardiac, and smooth muscle. The disease can affect multiple organ systems, notably the cardiovascular system. The introduction and approval of enzyme replacement therapy (alglucosidase alfa; Myozyme/Lumizyme) in 2006 dramatically changed the outlook for infantile-onset Pompe disease, transforming what was once a uniformly fatal cardiomyopathy into a treatable condition. Nonetheless, long-term follow-up of patients receiving enzyme replacement therapy has uncovered ongoing cardiac issues; persistent conduction defects, arrhythmias, and residual myocardial fibrosis highlight the need for continued cardiovascular monitoring in these individuals.
Insights
Pompe disease, a genetic disorder causing glycogen buildup, is now treatable with enzyme replacement therapy (ERT). However, long-term ERT requires ongoing cardiac monitoring due to persistent cardiovascular issues in patients.
Area of Science:
- Biochemistry
- Genetics
- Pediatrics
Background:
- Pompe disease is a rare, progressive, autosomal recessive lysosomal storage disorder.
- It stems from a deficiency in the acid α-glucosidase enzyme, leading to glycogen accumulation in lysosomes, particularly in muscles.
- Cardiovascular complications are a significant feature of Pompe disease.
Purpose of the Study:
- To review the impact of enzyme replacement therapy (ERT) on infantile-onset Pompe disease.
- To highlight persistent cardiac issues in patients undergoing long-term ERT.
- To emphasize the necessity of continued cardiovascular surveillance in Pompe disease patients.
Main Methods:
- Literature review of studies on Pompe disease and its treatment.
- Analysis of long-term follow-up data for patients receiving alglucosidase alfa.
- Evaluation of cardiovascular outcomes in treated individuals.
Main Results:
- Enzyme replacement therapy (alglucosidase alfa) has transformed infantile-onset Pompe disease from fatal to treatable.
- Long-term ERT is associated with ongoing cardiac problems, including conduction defects and arrhythmias.
- Residual myocardial fibrosis remains a concern in patients on long-term therapy.
Conclusions:
- While ERT has improved outcomes, Pompe disease management requires sustained attention to cardiac health.
- Continued cardiovascular monitoring is crucial for patients with Pompe disease on enzyme replacement therapy.
- Further research may be needed to address residual cardiac manifestations.
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