Fabry: ERT fails 20% of patients. See new targets. · The Monday Briefing, 9 November 2026

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Weekly Edition #46/26
November 9, 2026  ·  Weekly Newsletter
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Enzyme Replacement Therapy for Fabry disease has long been the cornerstone of managing globotriaosylceramide buildup. Yet, new therapies, such as substrate reduction and gene therapy, are challenging this standard. This tension reveals the complexities of treatment selection for this rare disorder.

1. **Substrate Reduction in Fabry Disease**: Emerging evidence suggests substrate reduction therapy may offer benefits where enzyme replacement falls short, particularly in targeting globotriaosylceramide accumulation. It matters.

2. **Local Corticosteroids for Uveitis**: Local implants of fluocinolone acetonide have shown to match systemic immunosuppression in controlling uveitis, with fewer systemic side effects. Clinicians noticed.

3. **Lactate Clearance in Sepsis**: Lactate clearance remains a misunderstood yet critical target in sepsis resuscitation. Its role requires careful application to avoid missteps.

These findings highlight a pattern: established treatments are continually being reevaluated in the face of new evidence. While enzyme replacement therapy remains vital, its limitations push the exploration of alternative approaches. In uveitis, local solutions may reduce systemic risks. And in sepsis, refining existing targets like lactate clearance can prevent misapplication.

Clinicians should critically assess emerging therapies and optimize current strategies to enhance patient outcomes. I read every reply.

Lysosomal Storage Disorders
Fabry disease, a rare X-linked lysosomal storage disorder, presents a complex therapeutic challenge for clinicians. Reduced alpha-galactosidase A activity leads to globotriaosylceramide accumulation, causing progressive renal failure, hypertrophic cardiomyopathy, and premature cerebral infarction. 1 Current treatment paradigms involve enzyme replacement, but emerging options like substrate reduction and gene therapy demand a deeper understanding of their respective roles and patient selection…
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