Distúrbio raro de armazenamento lisossômico caracterizado pelo acúmulo intralisossomal de sulfatídeos em vários tecidos, levando à deterioração progressiva da função motora e neurocognitiva.
Introdução
O que você precisa saber de cara
Distúrbio raro de armazenamento lisossômico caracterizado pelo acúmulo intralisossomal de sulfatídeos em vários tecidos, levando à deterioração progressiva da função motora e neurocognitiva.
Tem tratamento?
Escala de raridade
<1/50kMuito rara
1/20kRara
1/10kPouco freq.
1/5kIncomum
1/2k
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Sinais e sintomas
O que aparece no corpo e com que frequência cada sintoma acontece
Partes do corpo afetadas
+ 38 sintomas em outras categorias
Características mais comuns
Os sintomas variam de pessoa para pessoa. Abaixo estão as 98 características clínicas mais associadas, ordenadas por frequência.
Linha do tempo da pesquisa
Triagem neonatal (Teste do Pezinho)
A triagem neonatal permite diagnóstico precoce e início imediato do tratamento.
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Genética e causas
O que está alterado no DNA e como passa nas famílias
Genes associados
2 genes identificados com associação a esta condição. Padrão de herança: Autosomal recessive.
ATPase required for the post-translational delivery of tail-anchored (TA) proteins to the endoplasmic reticulum (PubMed:17382883). Recognizes and selectively binds the transmembrane domain of TA proteins in the cytosol. This complex then targets to the endoplasmic reticulum by membrane-bound receptors GET1/WRB and CAMLG/GET2, where the tail-anchored protein is released for insertion. This process is regulated by ATP binding and hydrolysis. ATP binding drives the homodimer towards the closed dime
CytoplasmEndoplasmic reticulumNucleus, nucleolus
Cardiomyopathy, dilated, 2H
A form of dilated cardiomyopathy, a disorder characterized by ventricular dilation and impaired systolic function, resulting in congestive heart failure and arrhythmia. Patients are at risk of premature death. CMD2H is an autosomal recessive form characterized by rapid progression and death in early infancy.
Protein insertase that mediates insertion of transmembrane proteins into the mitochondrial outer membrane (PubMed:36264797). Catalyzes insertion of proteins with alpha-helical transmembrane regions, such as signal-anchored, tail-anchored and multi-pass membrane proteins (By similarity). Does not mediate insertion of beta-barrel transmembrane proteins (By similarity). May play a role in apoptosis (PubMed:12377771)
Mitochondrion outer membrane
Medicamentos e terapias
Mecanismo: ARSA exogenous gene
Variantes genéticas (ClinVar)
708 variantes patogênicas registradas no ClinVar.
Classificação de variantes (ClinVar)
Distribuição de 1,300 variantes classificadas pelo ClinVar.
Vias biológicas (Reactome)
15 vias biológicas associadas aos genes desta condição.
Diagnóstico
Os sinais que médicos procuram e os exames que confirmam
Tratamento e manejo
Remédios, cuidados de apoio e o que precisa acompanhar
Onde tratar no SUS
Hospitais de referência no Brasil e o protocolo oficial do SUS (PCDT)
🇧🇷 Atendimento SUS — Leucodistrofia metacromática
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Dados de DATASUS/CNES, SBGM, ABNeuro e Ministério da Saúde. Sempre confirme a disponibilidade diretamente com o estabelecimento.
Pesquisa ativa
Ensaios clínicos abertos e novidades científicas recentes
Ensaios em destaque
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8 pesquisas recrutando participantes. Converse com seu médico sobre a possibilidade de participar.
Outros ensaios clínicos
51 ensaios clínicos encontrados, 11 ativos.
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Metachromatic leukodystrophy (MLD) is an autosomal recessive genetic disorder caused by arylsulfatase A (ARSA) deficiency. Patients with MLD exhibit a high prevalence of gallbladder polyps and intestinal metaplasia. Although these precancerous lesions may progress to malignancy over time, gallbladder cancer is rarely diagnosed in children. Here, we present a case of gallbladder mucinous adenocarcinoma in a 5-year-old child, detailing its clinical, imaging, pathological, and genetic characteristics. To our knowledge, this is one of the earliest documented instances of pediatric gallbladder mucinous adenocarcinoma in MLD. A 5-year-old male patient was admitted with a recurrent intermittent epigastric pain for over six months. Imaging examinations revealed an enlarged gallbladder and thickened gallbladder wall. The patient underwent cholecystectomy, and histopathological analysis confirmed mucinous adenocarcinoma with low-grade intraepithelial neoplasia. A low frequency (6.31%) of somatic KMT2C gene mutations (c.2922A > T, p.L974F) was detected in the tumor tissue. Ten months later, the patient was readmitted due to the onset of abnormal neuropsychiatric behaviors and significant regression in both cognitive and motor function. Brain MRI revealed multiple, bilateral, symmetrical abnormal signals within the cerebral white matter. Whole exome sequencing (WES) identified a homozygous missense variant (c.640G > A; p.Ala214Thr) in the ARSA gene. A diagnosis of MLD was established bases on clinical and molecular findings. Pediatric gallbladder cancer is extremely rare. Although the role of low-frequency (6.31%) KMT2C variant in carcinogenesis is uncertain. When accompanied by neurological symptoms, there is high suspicion for an underlying genetic etiology. Radiological imaging plays a critical role in providing indications for the diagnosis of leukodystrophy. And genetic testing is helpful in detecting germline variations and somatic mutations in tumor tissues.
The Impact of RNA Polymerase III-Related Leukodystrophy on Nonaffected Family Members: A Qualitative Study.
RNA polymerase III-related hypomyelinating leukodystrophy (POLR3-HLD) is a rare, neurodegenerative, brain white matter disorder characterized by hypomyelination, hypodontia, and hypogonadotropic hypogonadism. Due to the complex and progressive nature of this disorder, parents and siblings of patients face many potential challenges and stressors. We, therefore, sought to explore parents' and siblings' experiences to understand their specific needs and identify modifiable factors to limit familial burden and improve their quality of life. We conducted semistructured interviews with parents and siblings of patients with POLR3-HLD. Interview questions focused on the financial, emotional, and psychosocial impacts on parents, as well as siblings' relationship with their affected sibling and the psychosocial impacts they may have experienced. All interviews were recorded, transcribed, and analyzed using reflexive thematic analysis. Through the coding process, themes surrounding the impact on and experiences of parents and siblings were developed. Nineteen semistructured interviews with 24 parents and nine interviews with 9 siblings were completed between March and October 2023 and February and May 2024, respectively. Four themes from parent interviews included extensive caregiver burden, emotional and psychosocial challenges, the importance of parental self-health, and comfort in the leukodystrophy community. Three themes from sibling interviews included the spectrum of emotional impacts, limited knowledge about POLR3-HLD, and adapting to their sibling's needs. This study provides a comprehensive understanding of the family experience, identifying the common challenges and specific needs of parents and siblings, highlighting areas of improvement in the global care offered to this vulnerable patient population.
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Juvenile Metachromatic Leukodystrophy in a Seven-Year-Old Child With a Familial History: A Case Report Suggesting Saposin B Deficiency.
Metachromatic leukodystrophy (MLD) is a rare inherited disorder of the white matter with higher incidences in consanguineous populations. In children, manifestations vary with age of onset: early forms present with motor regression and developmental delay, whereas later forms begin with motor difficulties followed by behavioural or cognitive decline. We describe a 7-year-old boy with previously normal development who exhibited progressive motor deficits, speech difficulties, cognitive impairment, and loss of bladder control. Neurological examination revealed generalized hypotonia, areflexia, gait ataxia, and axial spasticity. Audiovisual function was preserved. Laboratory workup showed elevated urinary sulfatide levels despite normal enzymatic activity of the main sulfatide-degrading enzyme. Additional metabolic tests were unremarkable aside from signs of increased ketone bodies. Neuroimaging revealed white matter abnormalities consistent with a leukodystrophic process, and electrophysiological studies confirmed peripheral demyelination. Genetic analysis revealed a homozygous PSAP c.777G>A variant, affecting a gene essential for sulfatide degradation and suggesting a possible atypical form of MLD. This case highlights the diagnostic complexity of non-classical presentations and underscores the value of comprehensive metabolic and genetic evaluation. This case illustrates that MLD can present with normal enzymatic assays and highlights the importance of combined biochemical, neuroimaging, and genomic testing in children with rapid motor and cognitive decline.
Publicações recentes
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Molecular therapy : the journal of the American Society of Gene TherapyA systematic review of clinical effectiveness and safety for historical and current treatment options for metachromatic leukodystrophy in children, including atidarsagene autotemcel.
Orphanet journal of rare diseasesStagger along the Corpus Callosum - A Rare form of Adult Metachromatic Leukodystrophy.
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Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeuticsPredicting disease severity in metachromatic leukodystrophy using protein activity and a patient phenotype matrix.
Genome biologyGross Motor Function in Pediatric Onset TUBB4A-Related Leukodystrophy: GMFM-88 Performance and Validation of GMFC-MLD in TUBB4A.
Journal of child neurologyEvaluating meaningful changes in physical functioning and cognitive declines in metachromatic leukodystrophy: a caregiver interview study.
Journal of patient-reported outcomesHypomyelination caused by a novel homozygous pathogenic variant in FOLR1: complete clinical and radiological recovery with oral folinic acid therapy and review of the literature.
Orphanet journal of rare diseasesLate infantile and adult-onset metachromatic leukodystrophy due to novel missense variants in the PSAP gene: Case report from India.
JIMD reportsMetachromatic leukodystrophy: To screen or not to screen?
European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology SocietySafety and Efficacy of Intravenous and Intrathecal Delivery of AAV9-Mediated ARSA in Minipigs.
International journal of molecular sciencesAn in silico approach to identify early damage biomarker candidates in metachromatic leukodystrophy.
Molecular genetics and metabolism reportsThe Experience of Parents of Children With Genetically Determined Leukoencephalopathies With the Health Care System: A Qualitative Study.
Journal of child neurologyNeurodegenerative disease after hematopoietic stem cell transplantation in metachromatic leukodystrophy.
Annals of clinical and translational neurologyCraniofacial features of POLR3-related leukodystrophy caused by biallelic variants in POLR3A, POLR3B and POLR1C.
Journal of medical geneticsA zebrafish model of combined saposin deficiency identifies acid sphingomyelinase as a potential therapeutic target.
Disease models & mechanismsDecreased RNA polymerase III subunit expression leads to defects in oligodendrocyte development.
Frontiers in neurosciencePreserving Ambulation in a Gene Therapy-Treated Girl Affected by Metachromatic Leukodystrophy: A Case Report.
Journal of personalized medicineSolving inherited white matter disorder etiologies in the neurology clinic: Challenges and lessons learned using next-generation sequencing.
Frontiers in neurologyClinical Significance of Diffusion Tensor Imaging in Metachromatic Leukodystrophy.
NeuropediatricsBasal nuclei are not involved in early metachromatic leukodystrophy.
Clinical neurology and neurosurgerySingle Systemic Administration of a Gene Therapy Leading to Disease Treatment in Metachromatic Leukodystrophy Arsa Knock-Out Mice.
The Journal of neuroscience : the official journal of the Society for NeuroscienceCombined saposin deficiency: A rare occurrence.
Medical journal, Armed Forces IndiaNovel in-frame duplication variant characterization in late infantile metachromatic leukodystrophy using whole-exome sequencing and molecular dynamics simulation.
PloS oneGene Therapy of Sphingolipid Metabolic Disorders.
International journal of molecular sciencesCorrigendum to "Predicting clinical phenotypes of metachromatic leukodystrophy based on the arylsulfatase A activity and the ARSA genotype? - Chances and challenges" Mol Genet Metab/Vol 137/Issue 3/2022/ 273-282.
Molecular genetics and metabolismInfantile Metachromatic Leukodystrophy (MLD): A Rare Case.
CureusExpression of prosaposin and its G protein-coupled receptor (GPR) 37 in mouse cochlear and vestibular nuclei.
The Journal of veterinary medical scienceMR-spectroscopy in metachromatic leukodystrophy: A model free approach and clinical correlation.
NeuroImage. ClinicalBasal nuclei lesions and cholecystitis as initial findings of late infantile metachromatic leukodystrophy.
Clinical neurology and neurosurgeryEarly recognition of patients with leukodystrophies.
Current problems in pediatric and adolescent health careExperiences of patients and their family members with metachromatic leukodystrophy, adrenoleukodystrophy, and Krabbe disease: a qualitative systematic review protocol.
JBI evidence synthesisRiluzole partially restores RNA polymerase III complex assembly in cells expressing the leukodystrophy-causative variant POLR3B R103H.
Molecular brainEvaluating brain white matter hyperintensity, IQ scores, and plasma neurofilament light chain concentration in early-treated patients with infantile-onset Pompe disease.
Genetics in medicine : official journal of the American College of Medical GeneticsRecognizing early MRI signs (or their absence) is crucial in diagnosing metachromatic leukodystrophy.
Annals of clinical and translational neurologyThe importance of early diagnosis and views on newborn screening in metachromatic leukodystrophy: results of a Caregiver Survey in the UK and Republic of Ireland.
Orphanet journal of rare diseasesCase report: A compound heterozygous mutations in ARSA associated with adult-onset metachromatic leukodystrophy.
Frontiers in neurologyPhenotypic continuum of NFU1-related disorders.
Annals of clinical and translational neurologyPredicting clinical phenotypes of metachromatic leukodystrophy based on the arylsulfatase A activity and the ARSA genotype? - Chances and challenges.
Molecular genetics and metabolismUnderstanding caregiver descriptions of initial signs and symptoms to improve diagnosis of metachromatic leukodystrophy.
Orphanet journal of rare diseases[Analysis of genetic variant in a patient with juvenile meterochromic leukodystrophy].
Zhonghua yi xue yi chuan xue za zhi = Zhonghua yixue yichuanxue zazhi = Chinese journal of medical geneticsCurrent Understanding on the Genetic Basis of Key Metabolic Disorders: A Review.
BiologyA Versatile and Scalable Platform That Streamlines Data Collection for Patient-Centered Studies: Usability and Feasibility Study.
JMIR formative researchClinical Reasoning: A 23-Year-Old Woman Presenting With Cognitive Impairment and Gait Disturbance.
NeurologyAn international study of caregiver-reported burden and quality of life in metachromatic leukodystrophy.
Orphanet journal of rare diseasesPearls & Oy-sters: Tumefactive Demyelinating Lesions With MOG Antibodies Preceding Late Infantile Metachromatic Leukodystrophy.
NeurologySegmentation of intrinsically very low contrast magnetic resonance brain images using tensor-based DTI registration.
Neuroimage. ReportsDiagnostic Overshadowing: Insidious Neuroregression Mimicking Presentation of Autism Spectrum Disorder.
Journal of developmental and behavioral pediatrics : JDBPA model of metformin mitochondrial metabolism in metachromatic leukodystrophy: first description of human Schwann cells transfected with CRISPR-Cas9.
Open biologyAnalysis of Fertility Preservation by Ovarian Tissue Cryopreservation in Pediatric Children in China.
Frontiers in endocrinologyExtremely low arylsulfatase A enzyme activity does not necessarily cause symptoms: A long-term follow-up and review of the literature.
JIMD reportsGeneration and characterization of motor neuron progenitors and motor neurons using metachromatic leukodystrophy-induced pluripotent stem cells.
Molecular genetics and metabolism reportsHematopoietic Stem Cell Transplantation for Children With Inborn Errors of Metabolism: Single Center Experience Over Two Decades.
Indian pediatricsMyelin oligodendrocyte glycoprotein antibodies in genetic leukodystrophies.
Journal of neuroimmunologyNew Indications for Hematopoietic Stem Cell Gene Therapy in Lysosomal Storage Disorders.
Frontiers in oncologyAssociações
Organizações que acompanham esta doença — pra ter apoio e orientação
Associação brasileira dedicada a Adrenoleucodistrofia.
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Ainda não existe comunidade no Raras para Leucodistrofia metacromática
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Referências e fontes
Bases de dados externas citadas neste artigo
Publicações científicas
Artigos indexados no PubMed ligados a esta doença no grafo RarasNet — título, periódico e PMID direto da fonte, sem intermediação de IA.
- Gallbladder mucinous carcinoma in a child with metachromatic leukodystrophy, case report and literature review.
- The Impact of RNA Polymerase III-Related Leukodystrophy on Nonaffected Family Members: A Qualitative Study.
- Two Novel Mutations in the PSAP Gene Causing a Metachromatic Leukodystrophy (MLD)-like Phenotype and a Review of the Literature.
- Multiparametric MRI analysis of clinical outcome after hematopoietic stem cell transplantation in juvenile Metachromatic Leukodystrophy.
- Juvenile Metachromatic Leukodystrophy in a Seven-Year-Old Child With a Familial History: A Case Report Suggesting Saposin B Deficiency.
- Metachromatic leukodystrophy (MLD) in France: the views of family caregivers on the diagnosis of the disease, its daily burden on their child, and the whole family.
- Longitudinal MRI-based changes in intracranial volume and skull thickness observed in both metachromatic leukodystrophy and multiple sclerosis.
- Prosaposin in CNS health and disease, metabolic stress and exercise adaptation.
Bases de dados e fontes oficiais
Identificadores e referências canônicas usadas para montar este verbete.
- ORPHA:512(Orphanet)
- MONDO:0018868(MONDO)
- GARD:3230(GARD (NIH))
- Variantes catalogadas(ClinVar)
- Busca completa no PubMed(PubMed)
- Artigo Wikipedia(Wikipedia)
- Q1120682(Wikidata)
Dados compilados pelo RarasNet a partir de fontes abertas (Orphanet, OMIM, MONDO, PubMed/EuropePMC, ClinicalTrials.gov, DATASUS, PCDT/MS). Este conteúdo é informativo e não substitui avaliação médica.
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