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Mental disorders in neurological diseases. Can symptoms of bipolar disorder be the first manifestation of X-linked adenoleukodystrophy? A case report. CURRENT PROBLEMS OF PSYCHIATRY 2020. [DOI: 10.2478/cpp-2020-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background: X-linked adrenoleukodystrophy (X-ALD) is an inherited metabolic disease which causes demyelination of the white matter of the brain. The symptoms include mental impairment, progressive paresis, impaired motor coordination, and epileptic seizures. Diagnosis is established mainly by genetic testing. Currently, the recommended treatment is haematopoietic stem cell transplantation (HSCT).
Goal: The aim of the study was to present the case of a patient suffering from X-ALD, who developed symptoms of bipolar disorder in the initial phase of the disease prior to the onset of characteristic neurological symptoms.
Case presentation: In 2015, a 33-year-old patient was admitted to a psychiatric department due to aggressive behaviour he showed towards his wife and other family members. He had been treated for a depressive episode in 2005, and for a manic episode without psychotic symptoms earlier in 2015. During the successive psychiatric hospitalizations, in addition to psychopathological symptoms, the patient had been observed to have neurological symptoms, which included progressive paraparesis and ataxia. In 2018, based on imaging and genetic tests, the patient was diagnosed with X-ALD. The patient’s condition gradually deteriorated; with time, he was unable to move on his own. During a hospital stay in 2019, he was transferred to an internal medicine department due to a progressive urinary tract infection, which, however, could not be controlled, and the patient died.
Conclusions:
1. X-ALD is a rare metabolic illness. In the early stages of the disease, various psychopathological symptoms, including affective disorders, are observed.
2. Early initiation of adequate treatment increases the chances of extending the patient’s life.
3. In the present case, the patient did not die due to the underlying disease, but due to causes typical of bed-bound patients, i.e. complications of progressing infection.
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Wiesinger C, Eichler FS, Berger J. The genetic landscape of X-linked adrenoleukodystrophy: inheritance, mutations, modifier genes, and diagnosis. APPLICATION OF CLINICAL GENETICS 2015; 8:109-21. [PMID: 25999754 PMCID: PMC4427263 DOI: 10.2147/tacg.s49590] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
X-linked adrenoleukodystrophy (X-ALD) is caused by mutations in the ABCD1 gene encoding a peroxisomal ABC transporter. In this review, we compare estimates of incidence derived from different populations in order to provide an overview of the worldwide incidence of X-ALD. X-ALD presents with heterogeneous phenotypes ranging from adrenomyeloneuropathy (AMN) to inflammatory demyelinating cerebral ALD (CALD). A large number of different mutations has been described, providing a unique opportunity for analysis of functional domains within ABC transporters. Yet the molecular basis for the heterogeneity of clinical symptoms is still largely unresolved, as no correlation between genotype and phenotype exists in X-ALD. Beyond ABCD1, environmental triggers and other genetic factors have been suggested as modifiers of the disease course. Here, we summarize the findings of numerous reports that aimed at identifying modifier genes in X-ALD and discuss potential problems and future approaches to address this issue. Different options for prenatal diagnosis are summarized, and potential pitfalls when applying next-generation sequencing approaches are discussed. Recently, the measurement of very long-chain fatty acids in lysophosphatidylcholine for the identification of peroxisomal disorders was included in newborn screening programs.
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Affiliation(s)
- Christoph Wiesinger
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Florian S Eichler
- Department for Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Johannes Berger
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University of Vienna, Vienna, Austria
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Ferrer I, Aubourg P, Pujol A. General aspects and neuropathology of X-linked adrenoleukodystrophy. Brain Pathol 2010; 20:817-30. [PMID: 20626743 DOI: 10.1111/j.1750-3639.2010.00390.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
X-adrenoleukodystrophy (X-ALD) is a metabolic, peroxisomal disease affecting the nervous system, adrenal cortex and testis resulting from inactivating mutations in ABCD1 gene which encodes a peroxisomal membrane half-adenosine triphosphate (ATP)-binding cassette transporter, ABCD1 (or ALDP), whose defect is associated with impaired peroxisomal beta-oxidation and accumulation of saturated very long-chain fatty acids (VLCFA) in tissues and body fluids. Several phenotypes are recognized in male patients including cerebral ALD in childhood, adolescence or adulthood, adrenomyeloneuropathy (AMN), Addison's disease and, eventually, gonadal insufficiency. Female carriers might present with mild to severe myeloneuropathy that resembles AMN. There is a lack of phenotype-genotype correlations, as the same ABCD1 gene mutation may be associated with different phenotypes in the same family, suggesting that genetic, epigenetic, environmental and stochastic factors are probably contributory to the development and course of the disease. Degenerative changes, like those seen in pure AMN without cerebral demyelination, are characterized by loss of axons and secondary myelin in the long tracts of the spinal cord, possibly related to the impaired lipid metabolism of VLCFAs and the associated alterations (ie, oxidative damage). Similar lesions are encountered following inactivation of ABCD1 in mice (ABCD1(-)). A different and more aggressive phenotype is secondary to cerebral demyelination, very often accompanied by inflammatory changes in the white matter of the brain and associated with activation of T lymphocytes, CD1 presentation and increased levels of cytokines, gamma-interferon, interleukin (IL)-1alpha, IL-2 and IL-6, Granulocyte macrophage colony-stimulating factor (GM-CSF), tumor necrosis factor-alpha, chemokines and chemokine receptors.
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Affiliation(s)
- Isidro Ferrer
- Institut Neuropatologia, Servei Anatomia Patològica, Institut d'Investigació Biomèdica de Bellvitge IDIBELL-Hospital Universitari de Bellvitge, Hospitalet de Llobregat, CIBERNED, Spain.
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Semmler A, Köhler W, Jung HH, Weller M, Linnebank M. Therapy of X-linked adrenoleukodystrophy. Expert Rev Neurother 2008; 8:1367-79. [PMID: 18759549 DOI: 10.1586/14737175.8.9.1367] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
X-linked adrenoleukodystrophy (X-ALD; OMIM #300100) is caused by defects of the ABCD1 gene on chromosome Xq28, resulting in an impairment of peroxisomal beta-oxidation and the accumulation of saturated very long chain fatty acids (VLCFAs). Primary manifestations occur in the CNS, the adrenal cortex and the testes' Leydig cells. The clinical presentation shows a marked variability which is not explained by the different X-ALD genotypes. Phenotypes range from rapidly progressive cerebral disease with childhood (childhood cerebral ALD [CCALD]) or adulthood (adult cerebral ALD [ACALD]) onset leading to death within a few years, over adult-onset adrenomyeloneuropathy (AMN) with or without focal CNS demyelination, AMN converting into a rapidly progressive, cerebral demyelinating phenotype resembling CCALD, to slow disease progression over decades, or adrenal insufficiency only. Approximately 50% of female heterozygotes develop moderate spastic paresis resembling the AMN phenotype. This review focuses on current experiences with different therapeutic approaches. Lorenzo's oil did not prove to be effective in cerebral inflammatory disease variants, but asymptomatic patients, and speculatively AMN variants without cerebral involvement, as well as female carriers may benefit from early intake of oleic and erucic acids in addition to VLCFA restriction. Hormone-replacement therapy is necessary in all patients with adrenal insufficiency. Hematopoietic stem cell transplantation has been reported to be effective in presymptomatic or early symptomatic CCALD, and may well also be a final therapeutic option in early ACALD patients. Early detection of mutation carriers and timely initiation of therapy is important for the effectiveness of all therapeutic efforts. Gene therapy of endogenous hematopoietic stem cells, pharmacological upregulation of other genes encoding proteins involved in peroxisomal beta-oxidation, reduction of oxidative stress, and possibly lovastatin are candidates for future X-ALD therapies.
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Affiliation(s)
- Alexander Semmler
- University Hospital Zürich, Department of Neurology, Frauenklinikstr. 26, CH-8091 Zürich, Switzerland
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Corzo D, Gibson W, Johnson K, Mitchell G, LePage G, Cox GF, Casey R, Zeiss C, Tyson H, Cutting GR, Raymond GV, Smith KD, Watkins PA, Moser AB, Moser HW, Steinberg SJ. Contiguous deletion of the X-linked adrenoleukodystrophy gene (ABCD1) and DXS1357E: a novel neonatal phenotype similar to peroxisomal biogenesis disorders. Am J Hum Genet 2002; 70:1520-31. [PMID: 11992258 PMCID: PMC419992 DOI: 10.1086/340849] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2002] [Accepted: 03/19/2002] [Indexed: 11/03/2022] Open
Abstract
X-linked adrenoleukodystrophy (X-ALD) results from mutations in ABCD1. ABCD1 resides on Xq28 and encodes an integral peroxisomal membrane protein (ALD protein [ALDP]) that is of unknown function and that belongs to the ATP-binding cassette-transporter superfamily. Individuals with ABCD1 mutations accumulate very-long-chain fatty acids (VLCFA) (carbon length >22). Childhood cerebral X-ALD is the most devastating form of the disease. These children have the earliest onset (age 7.2 +/- 1.7 years) among the clinical phenotypes for ABCD1 mutations, but onset does not occur at <3 years of age. Individuals with either peroxisomal biogenesis disorders (PBD) or single-enzyme deficiencies (SED) in the peroxisomal beta-oxidation pathway--disorders such as acyl CoA oxidase deficiency and bifunctional protein deficiency--also accumulate VLCFA, but they present during the neonatal period. Until now, it has been possible to distinguish unequivocally between individuals with these autosomal recessively inherited syndromes and individuals with ABCD1 mutations, on the basis of the clinical presentation and measurement of other biochemical markers. We have identified three newborn boys who had clinical symptoms and initial biochemical results consistent with PBD or SED. In further study, however, we showed that they lacked ALDP, and we identified deletions that extended into the promoter region of ABCD1 and the neighboring gene, DXS1357E. Mutations in DXS1357E and the ABCD1 promoter region have not been described previously. We propose that the term "contiguous ABCD1 DXS1357E deletion syndrome" (CADDS) be used to identify this new contiguous-gene syndrome. The three patients with CADDS who are described here have important implications for genetic counseling, because individuals with CADDS may previously have been misdiagnosed as having an autosomal recessive PBD or SED
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily D, Member 1
- ATP-Binding Cassette Transporters/genetics
- Adrenoleukodystrophy/diagnosis
- Adrenoleukodystrophy/genetics
- Adrenoleukodystrophy/metabolism
- Adrenoleukodystrophy/physiopathology
- Age of Onset
- Chemokine CCL22
- Chemokines, CC/genetics
- Child
- Child, Preschool
- Exons/genetics
- Female
- Fibroblasts
- Genetic Complementation Test
- Heterozygote
- Humans
- Infant
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/genetics
- Infant, Newborn, Diseases/metabolism
- Infant, Newborn, Diseases/physiopathology
- Male
- Membrane Proteins/deficiency
- Membrane Proteins/genetics
- Peroxisomal Disorders/diagnosis
- Peroxisomal Disorders/genetics
- Peroxisomal Disorders/metabolism
- Peroxisomal Disorders/physiopathology
- Peroxisomes/metabolism
- Peroxisomes/pathology
- Phenotype
- Prenatal Diagnosis
- Promoter Regions, Genetic/genetics
- Proteins/genetics
- Sequence Deletion/genetics
- Syndrome
- X Chromosome/genetics
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Affiliation(s)
- Deyanira Corzo
- Division of Genetics, The Children’s Hospital, Boston; Medical Genetics and Gastroeneterology Services, Hôpital Ste-Justine, Montreal; The Kennedy Krieger Institute, and Institute of Genetic Medicine and Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore; Departments of Medical Genetics and Pediatrics, Alberta Children’s Hospital and University of Calgary, Calgary; and Section of Comparative Medicine, Yale University School of Medicine, New Haven, CT
| | - William Gibson
- Division of Genetics, The Children’s Hospital, Boston; Medical Genetics and Gastroeneterology Services, Hôpital Ste-Justine, Montreal; The Kennedy Krieger Institute, and Institute of Genetic Medicine and Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore; Departments of Medical Genetics and Pediatrics, Alberta Children’s Hospital and University of Calgary, Calgary; and Section of Comparative Medicine, Yale University School of Medicine, New Haven, CT
| | - Kisha Johnson
- Division of Genetics, The Children’s Hospital, Boston; Medical Genetics and Gastroeneterology Services, Hôpital Ste-Justine, Montreal; The Kennedy Krieger Institute, and Institute of Genetic Medicine and Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore; Departments of Medical Genetics and Pediatrics, Alberta Children’s Hospital and University of Calgary, Calgary; and Section of Comparative Medicine, Yale University School of Medicine, New Haven, CT
| | - Grant Mitchell
- Division of Genetics, The Children’s Hospital, Boston; Medical Genetics and Gastroeneterology Services, Hôpital Ste-Justine, Montreal; The Kennedy Krieger Institute, and Institute of Genetic Medicine and Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore; Departments of Medical Genetics and Pediatrics, Alberta Children’s Hospital and University of Calgary, Calgary; and Section of Comparative Medicine, Yale University School of Medicine, New Haven, CT
| | - Guy LePage
- Division of Genetics, The Children’s Hospital, Boston; Medical Genetics and Gastroeneterology Services, Hôpital Ste-Justine, Montreal; The Kennedy Krieger Institute, and Institute of Genetic Medicine and Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore; Departments of Medical Genetics and Pediatrics, Alberta Children’s Hospital and University of Calgary, Calgary; and Section of Comparative Medicine, Yale University School of Medicine, New Haven, CT
| | - Gerald F. Cox
- Division of Genetics, The Children’s Hospital, Boston; Medical Genetics and Gastroeneterology Services, Hôpital Ste-Justine, Montreal; The Kennedy Krieger Institute, and Institute of Genetic Medicine and Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore; Departments of Medical Genetics and Pediatrics, Alberta Children’s Hospital and University of Calgary, Calgary; and Section of Comparative Medicine, Yale University School of Medicine, New Haven, CT
| | - Robin Casey
- Division of Genetics, The Children’s Hospital, Boston; Medical Genetics and Gastroeneterology Services, Hôpital Ste-Justine, Montreal; The Kennedy Krieger Institute, and Institute of Genetic Medicine and Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore; Departments of Medical Genetics and Pediatrics, Alberta Children’s Hospital and University of Calgary, Calgary; and Section of Comparative Medicine, Yale University School of Medicine, New Haven, CT
| | - Carolyn Zeiss
- Division of Genetics, The Children’s Hospital, Boston; Medical Genetics and Gastroeneterology Services, Hôpital Ste-Justine, Montreal; The Kennedy Krieger Institute, and Institute of Genetic Medicine and Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore; Departments of Medical Genetics and Pediatrics, Alberta Children’s Hospital and University of Calgary, Calgary; and Section of Comparative Medicine, Yale University School of Medicine, New Haven, CT
| | - Heidi Tyson
- Division of Genetics, The Children’s Hospital, Boston; Medical Genetics and Gastroeneterology Services, Hôpital Ste-Justine, Montreal; The Kennedy Krieger Institute, and Institute of Genetic Medicine and Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore; Departments of Medical Genetics and Pediatrics, Alberta Children’s Hospital and University of Calgary, Calgary; and Section of Comparative Medicine, Yale University School of Medicine, New Haven, CT
| | - Garry R. Cutting
- Division of Genetics, The Children’s Hospital, Boston; Medical Genetics and Gastroeneterology Services, Hôpital Ste-Justine, Montreal; The Kennedy Krieger Institute, and Institute of Genetic Medicine and Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore; Departments of Medical Genetics and Pediatrics, Alberta Children’s Hospital and University of Calgary, Calgary; and Section of Comparative Medicine, Yale University School of Medicine, New Haven, CT
| | - Gerald V. Raymond
- Division of Genetics, The Children’s Hospital, Boston; Medical Genetics and Gastroeneterology Services, Hôpital Ste-Justine, Montreal; The Kennedy Krieger Institute, and Institute of Genetic Medicine and Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore; Departments of Medical Genetics and Pediatrics, Alberta Children’s Hospital and University of Calgary, Calgary; and Section of Comparative Medicine, Yale University School of Medicine, New Haven, CT
| | - Kirby D. Smith
- Division of Genetics, The Children’s Hospital, Boston; Medical Genetics and Gastroeneterology Services, Hôpital Ste-Justine, Montreal; The Kennedy Krieger Institute, and Institute of Genetic Medicine and Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore; Departments of Medical Genetics and Pediatrics, Alberta Children’s Hospital and University of Calgary, Calgary; and Section of Comparative Medicine, Yale University School of Medicine, New Haven, CT
| | - Paul A. Watkins
- Division of Genetics, The Children’s Hospital, Boston; Medical Genetics and Gastroeneterology Services, Hôpital Ste-Justine, Montreal; The Kennedy Krieger Institute, and Institute of Genetic Medicine and Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore; Departments of Medical Genetics and Pediatrics, Alberta Children’s Hospital and University of Calgary, Calgary; and Section of Comparative Medicine, Yale University School of Medicine, New Haven, CT
| | - Ann B. Moser
- Division of Genetics, The Children’s Hospital, Boston; Medical Genetics and Gastroeneterology Services, Hôpital Ste-Justine, Montreal; The Kennedy Krieger Institute, and Institute of Genetic Medicine and Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore; Departments of Medical Genetics and Pediatrics, Alberta Children’s Hospital and University of Calgary, Calgary; and Section of Comparative Medicine, Yale University School of Medicine, New Haven, CT
| | - Hugo W. Moser
- Division of Genetics, The Children’s Hospital, Boston; Medical Genetics and Gastroeneterology Services, Hôpital Ste-Justine, Montreal; The Kennedy Krieger Institute, and Institute of Genetic Medicine and Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore; Departments of Medical Genetics and Pediatrics, Alberta Children’s Hospital and University of Calgary, Calgary; and Section of Comparative Medicine, Yale University School of Medicine, New Haven, CT
| | - Steven J. Steinberg
- Division of Genetics, The Children’s Hospital, Boston; Medical Genetics and Gastroeneterology Services, Hôpital Ste-Justine, Montreal; The Kennedy Krieger Institute, and Institute of Genetic Medicine and Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore; Departments of Medical Genetics and Pediatrics, Alberta Children’s Hospital and University of Calgary, Calgary; and Section of Comparative Medicine, Yale University School of Medicine, New Haven, CT
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