The observed coexistence of autoimmune phenomena, such as ANCA PR3-positive vasculitis in P7, underscores the need for systematic immunological surveillance in Fabry patients, particularly those with suggestive personal or family histories38,39 Additionally, the correlation between anti-ERT antibodies and broader immune activation suggests their potential role as functional biomarkers rather than mere therapeutic obstacles.26,33. This evidence concerns the gene ELF3 and vasculitis.