Characterization of small fiber pathology in a mouse model of Fabry disease

Fabry disease (FD) is a life-threatening X-linked lysosomal storage disorder caused by alpha-galactosidase A (alpha-GAL) deficiency. Small fiber pathology and pain are major FD symptoms of unknown pathophysiology. alpha-GAL deficient mice (GLA KO) age-dependently accumulate globotriaosylceramide (Gb3) in dorsal root ganglion (DRG) neurons paralleled by endoplasmic stress and apoptosis as contributors to skin denervation. Old GLA KO mice show increased TRPV1 protein in DRG neurons and heat hypersensitivity upon i.pl. capsaicin. In turn, GLA KO mice are protected from heat and mechanical hypersensitivity in neuropathic and inflammatory pain models based on reduced neuronal I-h and Na-v 1.7 currents. We show that in vitro alpha-GAL silencing increases intracellular Gb3 accumulation paralleled by loss of Na-v 1.7 currents, which is reversed by incubation with agalsidase-alpha and lucerastat. We provide first evidence of a direct Gb3 effect on neuronal integrity and ion channel function as potential mechanism underlying pain and small fiber pathology in FD.