A doença de armazenamento lipídico neutro (NLSD) refere-se a um grupo de doenças caracterizadas por um déficit na degradação de triglicerídeos citoplasmáticos e seu acúmulo em vacúolos lipídicos citoplasmáticos na maioria dos tecidos do corpo. O grupo é heterogêneo: atualmente podem ser distinguidos casos de NLSD com ictiose (NLSDI/doença de Dorfman-Chanarin) e NLSD com miopatia (NLSDM/miopatia de armazenamento lipídico neutro).
Introdução
O que você precisa saber de cara
A doença de armazenamento lipídico neutro (NLSD) refere-se a um grupo de doenças caracterizadas por um déficit na degradação de triglicerídeos citoplasmáticos e seu acúmulo em vacúolos lipídicos citoplasmáticos na maioria dos tecidos do corpo. O grupo é heterogêneo: atualmente podem ser distinguidos casos de NLSD com ictiose (NLSDI/doença de Dorfman-Chanarin) e NLSD com miopatia (NLSDM/miopatia de armazenamento lipídico neutro).
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
+ 29 sintomas em outras categorias
Características mais comuns
Os sintomas variam de pessoa para pessoa. Abaixo estão as 89 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.
Coenzyme A-dependent lysophosphatidic acid acyltransferase that catalyzes the transfer of an acyl group on a lysophosphatidic acid (PubMed:18606822). Functions preferentially with 1-oleoyl-lysophosphatidic acid followed by 1-palmitoyl-lysophosphatidic acid, 1-stearoyl-lysophosphatidic acid and 1-arachidonoyl-lysophosphatidic acid as lipid acceptor. Functions preferentially with arachidonoyl-CoA followed by oleoyl-CoA as acyl group donors (By similarity). Functions in phosphatidic acid biosynthes
CytoplasmLipid dropletCytoplasm, cytosol
Chanarin-Dorfman syndrome
An autosomal recessive inborn error of lipid metabolism with multisystemic accumulation of triglycerides although plasma concentrations are normal. Clinical characteristics are congenital generalized ichthyosis, vacuolated leukocytes, hepatomegaly, myopathy, cataracts, neurosensory hearing loss and developmental delay. The disorder presents at birth with generalized, fine, white scaling of the skin and a variable degree of erythema resembling non-bullous congenital ichthyosiform erythroderma.
Catalyzes the initial step in triglyceride hydrolysis in adipocyte and non-adipocyte lipid droplets (PubMed:15364929, PubMed:15550674, PubMed:16150821, PubMed:16239926, PubMed:17603008, PubMed:34903883). Exhibits a strong preference for the hydrolysis of long-chain fatty acid esters at the sn-2 position of the glycerol backbone and acts coordinately with LIPE/HLS and DGAT2 within the lipolytic cascade (By similarity). Also possesses acylglycerol transacylase and phospholipase A2 activities (PubM
Lipid dropletCell membraneCytoplasm
Variantes genéticas (ClinVar)
131 variantes patogênicas registradas no ClinVar.
Vias biológicas (Reactome)
5 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 — Doença de armazenamento de lipídios neutros
Centros de Referência SUS
21 centros habilitados pelo SUS para Doença de armazenamento de lipídios neutros
Centros para Doença de armazenamento de lipídios neutros
Detalhes dos centros
Hospital Universitário Prof. Edgard Santos (HUPES)
R. Dr. Augusto Viana, s/n - Canela, Salvador - BA, 40110-060 · CNES 0003808
Serviço de Referência
Hospital de Apoio de Brasília (HAB)
AENW 3 Lote A Setor Noroeste - Plano Piloto, Brasília - DF, 70684-831 · CNES 0010456
Serviço de Referência
Hospital Estadual Infantil e Maternidade Alzir Bernardino Alves (HIABA)
Av. Min. Salgado Filho, 918 - Soteco, Vila Velha - ES, 29106-010 · CNES 6631207
Serviço de Referência
Hospital das Clínicas da UFG
Rua 235 QD. 68 Lote Área, Nº 285, s/nº - Setor Leste Universitário, Goiânia - GO, 74605-050 · CNES 2338424
Serviço de Referência
Hospital das Clínicas da UFMG
Av. Prof. Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte - MG, 30130-100 · CNES 2280167
Serviço de Referência
NUPAD / Faculdade de Medicina UFMG
Av. Prof. Alfredo Balena, 189 - 5 andar - Centro, Belo Horizonte - MG, 30130-100 · CNES 2183226
Serviço de Referência
Hospital Universitário João de Barros Barreto
R. dos Mundurucus, 4487 - Guamá, Belém - PA, 66073-000 · CNES 2337878
Serviço de Referência
Hospital de Clínicas da Universidade Federal de Pernambuco
Av. Prof. Moraes Rego, 1235 - Cidade Universitária, Recife - PE, 50670-901 · CNES 2561492
Atenção Especializada
Instituto de Medicina Integral Prof. Fernando Figueira (IMIP)
R. dos Coelhos, 300 - Boa Vista, Recife - PE, 50070-902 · CNES 0000647
Serviço de Referência
Hospital de Clínicas da UFPR
R. Gen. Carneiro, 181 - Alto da Glória, Curitiba - PR, 80060-900 · CNES 2364980
Serviço de Referência
Hospital Universitário Pedro Ernesto (HUPE-UERJ)
Blvd. 28 de Setembro, 77 - Vila Isabel, Rio de Janeiro - RJ, 20551-030 · CNES 2280221
Serviço de Referência
Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/Fiocruz)
Av. Rui Barbosa, 716 - Flamengo, Rio de Janeiro - RJ, 22250-020 · CNES 2269988
Serviço de Referência
Hospital Universitário Onofre Lopes (HUOL)
Av. Nilo Peçanha, 620 - Petrópolis, Natal - RN, 59012-300 · CNES 2408570
Atenção Especializada
Hospital São Lucas da PUCRS
Av. Ipiranga, 6690 - Jardim Botânico, Porto Alegre - RS, 90610-000 · CNES 2232928
Serviço de Referência
Hospital de Clínicas de Porto Alegre (HCPA)
Rua Ramiro Barcelos, 2350 Bloco A - Av. Protásio Alves, 211 - Bloco B e C - Santa Cecília, Porto Alegre - RS, 90035-903 · CNES 2237601
Serviço de Referência
Hospital Universitário da UFSC (HU-UFSC)
R. Profa. Maria Flora Pausewang - Trindade, Florianópolis - SC, 88036-800 · CNES 2560356
Serviço de Referência
Hospital das Clínicas da FMUSP
R. Dr. Ovídio Pires de Campos, 225 - Cerqueira César, São Paulo - SP, 05403-010 · CNES 2077485
Serviço de Referência
Hospital de Clínicas da UNICAMP
R. Vital Brasil, 251 - Cidade Universitária, Campinas - SP, 13083-888 · CNES 2748223
Serviço de Referência
Hospital de Clínicas de Ribeirão Preto (HCRP-USP)
R. Ten. Catão Roxo, 3900 - Vila Monte Alegre, Ribeirão Preto - SP, 14015-010 · CNES 2082187
Serviço de Referência
Instituto da Criança e do Adolescente (ICr-HCFMUSP)
Av. Dr. Enéas Carvalho de Aguiar, 647 - Cerqueira César, São Paulo - SP, 05403-000 · CNES 2081695
Serviço de Referência
UNIFESP / Hospital São Paulo
R. Napoleão de Barros, 715 - Vila Clementino, São Paulo - SP, 04024-002 · CNES 2688689
Serviço de Referência
Dados de DATASUS/CNES, SBGM, ABNeuro e Ministério da Saúde. Sempre confirme a disponibilidade diretamente com o estabelecimento.
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Publicações mais relevantes
Neutral Lipid Storage Disease with Myopathy: A Case Report with a Novel PNPLA2 Mutation.
Neutral lipid storage disease with myopathy (NLSDM) is a rare autosomal recessive disorder caused by mutations in the PNPLA2 gene, leading to defective triglyceride hydrolysis and lipid accumulation in tissues. We report a 28-year-old Indian female presented with a 4-year history of progressive, asymmetric limb weakness, elevated creatine kinase (1000 U/L), and vitiligo. Muscle magnetic resonance imaging (MRI) revealed asymmetric fatty infiltration. Muscle biopsy showed subtle vacuolar changes; notably, oil red O staining was negative, a known limitation in formalin-fixed tissue. Whole-exome sequencing identified a novel, likely pathogenic homozygous frameshift mutation, c. 212del, in exon 3 of PNPLA2, absent in population databases (gnomAD, ClinVar) and classified as likely pathogenic as per American College of Medical Genetics and Genomics (ACMG) criteria (PVS1, PM2). This case underscores the phenotypic variability of NLSDM and expands the genetic spectrum of the disease in the Indian population, highlighting the critical role of genetic testing for definitive diagnosis-particularly when histopathological lipid staining is unrevealing.
ATGL-mediated lipolysis is essential for myocellular mitochondrial function, mitochondria-lipid droplet interaction and mitochondrial network connectivity.
Defects in Adipose tissue TriGlyceride Lipase (ATGL)-mediated myocellular lipid droplet (LD) lipolysis results in mitochondrial dysfunction of unknown origin, which can be rescued by PPAR agonists. Here we examine if ATGL-mediated lipolysis is required to maintain mitochondrial network connectivity and function. Moreover, we explored if the functional implications of ATGL deficiency for mitochondrial network dynamics and function can be alleviated by promoting PPARα and/or PPARδ transcriptional activity. To this end, we cultured human primary myotubes from patients with neutral lipid storage disease with myopathy (NLSDM), a rare metabolic disorder caused by a mutation in the gene encoding for ATGL. These myotubes possess dysfunctional ATGL and compromised LD lipolysis. In addition, mitochondria-LD contact, mitochondrial network connectivity, and mitochondrial membrane potential were affected. Using a humanized ATGL inhibitor in myotubes (cultured form healthy donors) revealed similar results. Upon stimulating PPARδ transcriptional activity, mitochondrial respiration improved by more than 50 % in human primary myotubes from healthy lean individuals. This increase in respiration was dampened in myotubes with dysfunctional ATGL. Stimulation of PPARδ transcriptional activity had no effect on mitochondria-LD contacts, mitochondrial network connectivity, and mitochondrial membrane potential. Our results demonstrate that dysfunctional ATGL results in compromised mitochondrial-LD contacts and mitochondrial network connectivity, and that functional ATGL is required to improve mitochondrial respiratory capacity upon stimulation of PPARδ transcriptional activity.
Rare presentation as Dilated Cardiomyopathy: PNPLA2 Gene Mutation and Neutral Lipid Storage Disease with Myopathy.
Clinicopathological-genetic features of neutral lipid storage disease with myopathy from a Chinese neuromuscular center.
Neutral lipid storage disease with myopathy (NLSDM) is a rare genetic myopathy caused by mutations in the patatin-like phospholipase domain-containing protein (PNPLA2) gene. To date, the number of reported cases remains limited and the correlation between disease phenotypes and genotypes remains unclear. Our study presents eight NLSDM patients from a Chinese neuromuscular center, identifying two PNPLA2 novel mutations through next-generation sequencing. Demographic and clinical data, as well as information from muscle electrophysiological, imaging, pathological, and genetic analyses, were collected. Several patients in the cohort were found to have right upper extremity weakness as the initial clinical manifestation. Notably, the first patient with facial muscle involvement was reported in this series. Muscle histopathology revealed a characteristic accumulation of lipid droplets predominantly in type 1 muscle fibers, featuring type 1 fiber atrophy concurrent with type 2 fiber hypertrophy, which was systematically described first in a summary manner. This study prompted us to summarize abnormal clinicopathological features and explore the relationship between gene mutations and disease phenotypes in NLSDM.
Isolated Right Ventricular Hypertrophy: A Novel Cardiac Manifestation of Neutral Lipid Storage Disease.
Publicações recentes
Rare Presentation as Dilated Cardiomyopathy: PNPLA2 Gene Mutation and Neutral Lipid Storage Disease With Myopathy.
📖 RevisãoNeutral Lipid Storage Disease with Myopathy: A Case Report with a Novel PNPLA2 Mutation.
Isolated Right Ventricular Hypertrophy: A Novel Cardiac Manifestation of Neutral Lipid Storage Disease.
ATGL-mediated lipolysis is essential for myocellular mitochondrial function, mitochondria-lipid droplet interaction and mitochondrial network connectivity.
Long-term neuromuscular, cardiac and liver outcomes in an adult man affected with Chanarin-Dorfman syndrome.
📚 EuropePMC85 artigos no totalmostrando 72
Rare presentation as Dilated Cardiomyopathy: PNPLA2 Gene Mutation and Neutral Lipid Storage Disease with Myopathy.
The Canadian journal of cardiologyNeutral Lipid Storage Disease with Myopathy: A Case Report with a Novel PNPLA2 Mutation.
Annals of Indian Academy of NeurologyIsolated Right Ventricular Hypertrophy: A Novel Cardiac Manifestation of Neutral Lipid Storage Disease.
European heart journal. Cardiovascular ImagingATGL-mediated lipolysis is essential for myocellular mitochondrial function, mitochondria-lipid droplet interaction and mitochondrial network connectivity.
Biochimica et biophysica acta. Molecular and cell biology of lipidsLong-term neuromuscular, cardiac and liver outcomes in an adult man affected with Chanarin-Dorfman syndrome.
Molecular genetics and metabolism reportsCase Report: Pathogenic PNPLA2 variants and nonsense-mediated mRNA decay result in an early-onset neutral lipid storage disease with myopathy.
Frontiers in geneticsDefective targeting of PNPLA1 to lipid droplets causes ichthyosis in ABHD5-syndromic epidermal differentiation disorder.
Journal of lipid researchClinicopathological-genetic features of neutral lipid storage disease with myopathy from a Chinese neuromuscular center.
Orphanet journal of rare diseasesA Novel PNPLA2 Variant in a Female Patient with Neutral Lipid Storage Disease with Myopathy and Hypogonadotropic Hypogonadism.
Molecular syndromologyNeutral Lipid Storage Disease With Myopathy and Infiltrative Cardiomyopathy Initially Presenting as Right Arm Weakness.
JACC. Case reportsTwo PNPLA2 heterozygous mutations result in neutral lipid storage disease with myopathy: a case report.
BMC musculoskeletal disordersDilated cardiomyopathy caused by mutation of the PNPLA2 gene: a case report and literature review.
Frontiers in genetics[Clinical characteristics and genetic analysis of a child with Neutral lipid storage disease with myopathy].
Zhonghua yi xue yi chuan xue za zhi = Zhonghua yixue yichuanxue zazhi = Chinese journal of medical geneticsNeutral lipid storage disease with ichthyosis and fatty liver.
BMJ case reportsThe presence of white cell Jordan's anomaly in multiple Acyl-CoA dehydrogenase deficiency: A case report and implications for clinical practice.
Clinical biochemistryNeutral lipid storage disease with myopathy: clinicopathological and genetic features of nine Iranian patients.
Neuromuscular disorders : NMDHyperCKemia: An early sign of childhood-onset neutral lipid storage disease with myopathy.
Neuromuscular disorders : NMDNeutral lipid storage disease with myopathy and myotonia associated to pathogenic variants on PNPLA2 and CLCN1 genes: case report.
BMC neurologyNeutral lipid storage disease with myopathy with a novel homozygous PNPLA2 variant.
Clinical neurology and neurosurgeryEffects of Triheptanoin on Mitochondrial Respiration and Glycolysis in Cultured Fibroblasts from Neutral Lipid Storage Disease Type M (NLSD-M) Patients.
BiomoleculesCould "Islets of Sparing" Be a Clue for Neutral Lipid Storage Disease with Ichthyosis in Patients with Congenital Ichthyosiform Erythroderma?
Indian journal of dermatologyA novel homozygous missense mutation in PNPLA2 in a patient manifesting primary triglyceride deposit cardiomyovasculopathy.
Molecular genetics and metabolism reportsLate onset of neutral lipid storage disease due to a rare PNPLA2 mutation in a patient with myopathy and cardiomyopathy.
Chinese medical journalChanarin-Dorfman Syndrome: A Neutral Lipid Storage Disease With Ichthyosis and Liver Cirrhosis.
Journal of pediatric gastroenterology and nutritionBlocking Lipid Uptake Pathways Does not Prevent Toxicity in Adipose Triglyceride Lipase (ATGL) Deficiency.
Journal of lipid researchKnockdown of hepatocyte Perilipin-3 mitigates hepatic steatosis and steatohepatitis caused by hepatocyte CGI-58 deletion in mice.
Journal of molecular cell biologyNeutral lipid storage disease with myopathy: A 10-year follow-up case report.
European journal of translational myologyABHD5 frameshift deletion in Golden Retrievers with ichthyosis.
G3 (Bethesda, Md.)An Adolescent with Chanarin-Dorfman Syndrome Presenting with Ichthyosis and Hepatic Steatosis.
JPGN reportsMaternal Isodisomy of Chromosome 3 Combined with a De Novo Mutation in the ABHD5 Gene Causes Autosomal Recessive Chanarin-Dorfman Syndrome.
GenesRecurrent N209* ABHD5 mutation in two unreported families with Chanarin Dorfman Syndrome.
European journal of translational myologyJordans' Anomaly as a Red Flag for Neutral Lipid Storage Diseases.
Fetal and pediatric pathologyCase Report: PNPLA2 Gene Complex Heterozygous Mutation Leading to Neutral Lipid Storage Disease With Myopathy.
Frontiers in integrative neuroscienceEarly onset neutral lipid storage disease with myopathy presenting as congenital hypotonia and hepatomegaly.
Neuromuscular disorders : NMDNeutral lipid-storage disease with myopathy and Jordan anomaly.
NeurologyCGI-58: Versatile Regulator of Intracellular Lipid Droplet Homeostasis.
Advances in experimental medicine and biologyThe "discovery" of lipid droplets: A brief history of organelles hidden in plain sight.
Biochimica et biophysica acta. Molecular and cell biology of lipidsNeutral Lipid Storage Disease Associated with the PNPLA2 Gene: Case Report and Literature Review.
European neurologyThirty years of translational research in Mobility Medicine: Collection of abstracts of the 2020 Padua Muscle Days.
European journal of translational myologyLevitating Cells to Sort the Fit and the Fat.
Advanced biosystemsNeutral lipid storage disease with myopathy presenting asymmetrical muscle weakness: a case report.
International journal of clinical and experimental pathologyNext-generation sequencing through multi-gene panel testing for diagnosis of hereditary ichthyosis in Chinese.
Clinical geneticsThe lipid droplet-associated protein ABHD5 protects the heart through proteolysis of HDAC4.
Nature metabolismMiRNAs as biomarkers of phenotype in neutral lipid storage disease with myopathy.
Muscle & nerveNeutral lipid storage disease with myopathy in China: a large multicentric cohort study.
Orphanet journal of rare diseasesA novel PNPLA2 mutation causing total loss of RNA and protein expression in two NLSDM siblings with early onset but slowly progressive severe myopathy.
Genes & diseasesNeutral Lipid Storage Diseases as Cellular Model to Study Lipid Droplet Function.
CellsClinical findings and autophagic pathology in neutral lipid storage disease with myopathy.
Clinical neuropathologyNeutral lipid storage disease with myopathy and dropped head syndrome. Report of a new variant susceptible of treatment with late diagnosis.
Journal of clinical neuroscience : official journal of the Neurosurgical Society of AustralasiaNovel PNPLA2 gene mutation in a child causing neutral lipid storage disease with myopathy.
BMC medical geneticsLipid storage myopathies: Current treatments and future directions.
Progress in lipid researchNeutral lipid storage disease with myopathy: Further phenotypic characterization of a rare PNPLA2 variant.
Neuromuscular disorders : NMDPatients with neutral lipid storage disease with myopathy (NLSDM) in Southwestern China.
Clinical neurology and neurosurgeryPulmonary functions and sleep-related breathing disorders in lipid storage disease.
Sleep & breathing = Schlaf & AtmungThe phospholipase PNPLA7 functions as a lysophosphatidylcholine hydrolase and interacts with lipid droplets through its catalytic domain.
The Journal of biological chemistryMuscle MRI in neutral lipid storage disease (NLSD).
Journal of neurologyGeneration of induced Pluripotent Stem Cells as disease modelling of NLSDM.
Molecular genetics and metabolismLate onset of neutral lipid storage disease due to novel PNPLA2 mutations causing total loss of lipase activity in a patient with myopathy and slight cardiac involvement.
Neuromuscular disorders : NMDBasic utility of Pentra series automated hematology analyzer for screening of Jordans' anomaly.
International journal of laboratory hematologyClinical Reasoning: A 33-year-old man with cardiomyopathy and myopathy.
NeurologyAnalysis of lipid profile in lipid storage myopathy.
Journal of chromatography. B, Analytical technologies in the biomedical and life sciencesRegulation of Hepatic Triacylglycerol Metabolism by CGI-58 Does Not Require ATGL Co-activation.
Cell reportsWhole exome sequence analysis reveals a homozygous mutation in PNPLA2 as the cause of severe dilated cardiomyopathy secondary to neutral lipid storage disease.
International journal of cardiologySevere cardiomyopathy in a young patient with complete deficiency of adipose triglyceride lipase due to a novel mutation in PNPLA2 gene.
International journal of cardiologyNeutral lipid-storage disease with myopathy and extended phenotype with novel PNPLA2 mutation.
Muscle & nerveChanarin-Dorfman syndrome: A case report and review of the literature.
Arab journal of gastroenterology : the official publication of the Pan-Arab Association of GastroenterologyHypophagia and metabolic adaptations in mice with defective ATGL-mediated lipolysis cause resistance to HFD-induced obesity.
Proceedings of the National Academy of Sciences of the United States of AmericaChronic Liver Diseases in Children: Clinical Profile and Histology.
Journal of clinical and diagnostic research : JCDRDistinct cardiac phenotype between two homozygotes born in a village with accumulation of a genetic deficiency of adipose triglyceride lipase.
International journal of cardiologyNovel missense mutations in PNPLA2 causing late onset and clinical heterogeneity of neutral lipid storage disease with myopathy in three siblings.
Molecular genetics and metabolismCellular basis of secondary infections and impaired desquamation in certain inherited ichthyoses.
JAMA dermatologyFulminant lipid storage myopathy due to multiple acyl-coenzyme a dehydrogenase deficiency.
Muscle & nerveAssociações
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Comunidades
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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.
- Neutral Lipid Storage Disease with Myopathy: A Case Report with a Novel PNPLA2 Mutation.
- ATGL-mediated lipolysis is essential for myocellular mitochondrial function, mitochondria-lipid droplet interaction and mitochondrial network connectivity.
- Rare presentation as Dilated Cardiomyopathy: PNPLA2 Gene Mutation and Neutral Lipid Storage Disease with Myopathy.
- Clinicopathological-genetic features of neutral lipid storage disease with myopathy from a Chinese neuromuscular center.
- Isolated Right Ventricular Hypertrophy: A Novel Cardiac Manifestation of Neutral Lipid Storage Disease.
- Long-term neuromuscular, cardiac and liver outcomes in an adult man affected with Chanarin-Dorfman syndrome.
Bases de dados e fontes oficiais
Identificadores e referências canônicas usadas para montar este verbete.
- ORPHA:165(Orphanet)
- MONDO:0015611(MONDO)
- GARD:3262(GARD (NIH))
- Variantes catalogadas(ClinVar)
- Busca completa no PubMed(PubMed)
- Q7003001(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.
Conteúdo mantido por Agente Raras · Médicos e pesquisadores podem colaborar
