Enzyme replacement therapy for Fabry disease: possible strate-gies to improve its efficacy

Enzyme Replacement Therapy is the only therapeutic option for Fabry patients with completely absent AGAL activity. However, it has many limitations, in terms of costs, high rh-protein re-quired, and side effects; thus, its optimization would be beneficial for patients. In this paper, we describe preliminary results paving the way for two possible approaches: i. combination of en-zyme replacement therapy with pharmacological chaperones; ii. identification of approved drugs that affect the AGAL interactors' expression. We show that galactose, a low-affinity phar-macological chaperone, can prolong rh-AGAL half-life in FD cells. We compared the wild-type AGAL and the rh-AGAL interactomes and identified a list of drugs known to affect them. This list represents a starting point to deeply screen approved drugs and identify those that can bene-fit the enzyme replacement therapy and those that can negatively interfere with it.