Long-Term Monitoring of Cardiac Involvement under Migalastat Treatment Using Magnetic Resonance Tomography in Fabry Disease.

Background: Fabry cardiomyopathy is characterized by left ventricular hypertrophy, myocardial fibrosis, arrhythmia, and premature death. Treatment with migalastat, an oral pharmacological chaperone, was associated with a stabilization of cardiac biomarkers and a reduction in left ventricular mass index, as measured by echocardiography. A recent study, using cardiac magnetic resonance (CMR) as the gold standard, found a stable course of myocardial involvement after 18 months of treatment with migalastat. Our study aimed to provide long-term CMR data for the treatment with migalastat. Methods: A total of 11 females and four males with pathogenic amenable GLA mutations were treated with migalastat and underwent 1.5T CMR imaging for routine treatment effect monitoring. The main outcome was a long-term myocardial structural change, reflected by CMR. Results: After migalastat treatment initiation, left ventricular mass index, end diastolic volume, interventricular septal thickness, posterior wall thickness, estimated glomerular filtration rate, and plasma lyso-Gb3 remained stable during the median follow-up time of 34 months (min.: 25; max.: 47). The T1 relaxation times, reflecting glycosphingolipid accumulation and subsequent processes up to fibrosis, fluctuated over the time without a clear trend. No new onset of late gadolinium enhancement (LGE) areas, reflecting local fibrosis or scar formation of the myocardium, could be detected. However, patients with initially present LGE showed an increase in LGE as a percentage of left ventricular mass. The median α-galactosidase A enzymatic activity increased from 37.3% (IQR 5.88-89.3) to 105% (IQR 37.2-177) of the lower limit of the respective reference level (p = 0.005). Conclusion: Our study confirms an overall stable course of LVMi in patients with FD, treated with migalastat. However, individual patients may experience disease progression, especially those who present with fibrosis of the myocardium already at the time of therapy initiation. Thus, a regular treatment re-evaluation including CMR is needed to provide the optimal management for each patient.

Sequence-independent activation of photocycloadditions using two colours of light.

We exploit two reactive chromophores to establish sequence-independent photochemical activation, employing ortho-methyl benzaldehyde (oMBA) and N,N-(dimethylamino)pyrene aryl tetrazole (APAT) with N-(2-hydroxy)ethyl maleimide (NHEM), without any additives. Critically, the order of the irradiation sequence is irrelevant, as the shorter wavelength does not activate the higher wavelength activated species. Therefore, full sequence-independent λ-orthogonality is achieved through differences in both the reaction quantum yields (Φ r,oMBA and Φ r,APAT) and wavelength-dependent reactivity profiles of the employed chromophores.

Green-light induced cycloadditions.

We introduce a red-shifted tetrazole that is able to undergo efficient nitrile imine-mediated tetrazole-ene cycloaddition (NITEC) under blue and green light irradiation. We provide a detailed wavelength-dependent reactivity map, and employ a number of LEDs for high-conversion small molecule and polymer end-group modification.

Photocycloadditions in disparate chemical environments.

We elucidate the wavelength dependence of a photocycloaddition by (i) accessing action plots dependent on the reactivity relative to the number of absorbed photons, (ii) establishing the effect on substrate concentration on photochemical reactivity and (iii) determining wavelength-dependent reactivity as a function of the solvent environment, comparing acetonitrile with dimethyl sulfoxide.