Mechanism of action Fabry disease is a genetic disorder caused by various mutations of the enzyme α-GalA, which is responsible for breaking down the sphingolipid globotriaosylceramide (Gb3), among other glycolipids and glycoproteins. Some of these mutations result in misfolding of α-GalA, which subsequently fails protein quality control in the endoplasmic reticulum and is decomposed. Lack of functional α-GalA leads to accumulation of Gb3 in blood vessels and other tissues, with a wide range of symptoms including kidney, heart, and skin problems.<unk>  is a potent, orally available inhibitor of α-GalA (IC50: 4 μM). When binding to faulty α-GalA, it shifts the folding behaviour towards the proper conformation, resulting in a functional enzyme provided the mutation is amenable. Molecules with this type of mechanism are called pharmacological chaperones. When the enzyme reaches its destination, the lysosome,<unk>  dissociates because of the low pH and the relative abundance of Gb3 and other substrates, leaving α-GalA free to fulfill its function. Depending on the mutation, the EC50 is between 0.8 μM and over 1 mM in cellular models. File:PBB Protein GLA image.The enzyme alpha-galactosidase A (α-GalA) File:Globotriaosylceramide.Globotriaosylceramide (Gb3), a substrate of α-GalA, has a terminal D-galactose structurally similar to<unk> . File:1-Deoxygalactonojirimycin 2.Migalastat ("top" view) Pharmacokinetics<unk>  is almost completely absorbed from the gut; taking the drug together with food decreases its absorption by about 40%. Total bioavailability is about 75% when taken without food. The substance is not bound to blood plasma proteins. Only a small fraction of a<unk>  dose is metabolized, mainly to three dehydrogenated O-glucuronides (4% of the dose) and a number of unspecified metabolites (10%). The drug is mainly eliminated via the urine (77%) and to a smaller extent via the faeces (20%). Practically all of the metabolites are excreted in the urine. Elimination half-life is three to five hours after a single dose.
Migalastat
Cobicistat
Lazaretto
Miglustat
Truenat
Epiestriol
Lifitegrast
Ketotifen