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Síndrome Wolfram
ORPHA:3463CID-10 · E34.8CID-11 · 5A61.5DOENÇA RARA

A síndrome de Wolfram (WS), também conhecida como DIDMOAD, é uma doença neurodegenerativa caracterizada por diabetes mellitus tipo I (DM), diabetes insípido (DI), surdez neurossensorial (D), atrofia óptica bilateral (OA) e sinais neurológicos. Outros problemas relacionados são atonia do trato urinário, ataxia, neuropatia periférica, distúrbios psiquiátricos e/ou convulsões. Podem ser distinguidos 2 tipos de WS: tipo 1 e tipo 2 (WS1 e WS2).

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Introdução

O que você precisa saber de cara

📋

A síndrome de Wolfram (WS), também conhecida como DIDMOAD, é uma doença neurodegenerativa caracterizada por diabetes mellitus tipo I (DM), diabetes insípido (DI), surdez neurossensorial (D), atrofia óptica bilateral (OA) e sinais neurológicos. Outros problemas relacionados são atonia do trato urinário, ataxia, neuropatia periférica, distúrbios psiquiátricos e/ou convulsões. Podem ser distinguidos 2 tipos de WS: tipo 1 e tipo 2 (WS1 e WS2).

Pesquisas ativas
6 ensaios
14 total registrados no ClinicalTrials.gov
Publicações científicas
826 artigos
Último publicado: 2026 Apr 2
Medicamentos
5 registrados
VALPROIC ACID, VALPROATE SODIUM, TIRZEPATIDE

Tem tratamento?

5 medicamentos registrados
Ver detalhes, fases e interações →
VALPROIC ACIDVALPROATE SODIUMTIRZEPATIDEDANTROLENE SODIUMDANTROLENE

Escala de raridade

CLASSIFICAÇÃO ORPHANET · BRASIL 2024
1-9 / 1 000 000
Ultra-rara
<1/50k
Muito rara
1/20k
Rara
1/10k
Pouco freq.
1/5k
Incomum
1/2k
Prevalência
0.13
United Kingdom
Início
Adolescent
+ adult, childhood
🏥
SUS: Sem cobertura SUSScore: 0%
CID-10: E34.8
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Entender a doença

Do básico ao detalhe, leia no seu ritmo

Preparando trilha educativa...

Sinais e sintomas

O que aparece no corpo e com que frequência cada sintoma acontece

Partes do corpo afetadas

🧠
Neurológico
14 sintomas
📏
Crescimento
8 sintomas
👁️
Olhos
7 sintomas
🩸
Sangue
6 sintomas
🫘
Rins
5 sintomas
🦴
Ossos e articulações
4 sintomas

+ 15 sintomas em outras categorias

Características mais comuns

90%prev.
Diabetes mellitus
Muito frequente (99-80%)
90%prev.
Atrofia óptica
Muito frequente (99-80%)
90%prev.
Deficiência auditiva neurossensorial
Muito frequente (99-80%)
90%prev.
Diabetes insipidus
Muito frequente (99-80%)
90%prev.
Polidipsia
Muito frequente (99-80%)
55%prev.
Nistagmo
Frequente (79-30%)
68sintomas
Muito frequente (5)
Frequente (10)
Ocasional (24)
Sem dados (29)

Os sintomas variam de pessoa para pessoa. Abaixo estão as 68 características clínicas mais associadas, ordenadas por frequência.

Diabetes mellitus
Muito frequente (99-80%)90%
Atrofia ópticaOptic atrophy
Muito frequente (99-80%)90%
Deficiência auditiva neurossensorialSensorineural hearing impairment
Muito frequente (99-80%)90%
Diabetes insipidus
Muito frequente (99-80%)90%
PolidipsiaPolydipsia
Muito frequente (99-80%)90%

Linha do tempo da pesquisa

Publicações por ano — veja quando o interesse científico cresceu
Anos de pesquisa1desde 2026
Total histórico826PubMed
Últimos 10 anos200publicações
Pico202561 papers
Linha do tempo
2026Hoje · 2026🧪 2011Primeiro ensaio clínico📈 2025Ano de pico
Publicações por ano (últimos 10 anos)

Encontrou um erro ou informação desatualizada? Sugira uma correção →

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.

CISD2CDGSH iron-sulfur domain-containing protein 2Disease-causing germline mutation(s) inAltamente restrito
FUNÇÃO

Regulator of autophagy that contributes to antagonize BECN1-mediated cellular autophagy at the endoplasmic reticulum. Participates in the interaction of BCL2 with BECN1 and is required for BCL2-mediated depression of endoplasmic reticulum Ca(2+) stores during autophagy. Contributes to BIK-initiated autophagy, while it is not involved in BIK-dependent activation of caspases. Involved in life span control, probably via its function as regulator of autophagy

LOCALIZAÇÃO

Endoplasmic reticulum membraneMitochondrion outer membrane

MECANISMO DE DOENÇA

Wolfram syndrome 2

A rare disorder characterized by juvenile-onset insulin-dependent diabetes mellitus with optic atrophy. Other manifestations include diabetes insipidus, sensorineural deafness, dementia, psychiatric illnesses. WFS2 patients additionally show a strong bleeding tendency and gastrointestinal ulceration. Diabetes insipidus may be absent.

VIAS REACTOME (1)
INTERAÇÕES PROTEICAS (5)
OUTRAS DOENÇAS (2)
Wolfram syndrome 2Wolfram syndrome
HGNC:24212UniProt:Q8N5K1
WFS1WolframinDisease-causing germline mutation(s) (loss of function) inTolerante
FUNÇÃO

Participates in the regulation of cellular Ca(2+) homeostasis, at least partly, by modulating the filling state of the endoplasmic reticulum Ca(2+) store (PubMed:16989814). Negatively regulates the ER stress response and positively regulates the stability of V-ATPase subunits ATP6V1A and ATP1B1 by preventing their degradation through an unknown proteasome-independent mechanism (PubMed:23035048)

LOCALIZAÇÃO

Endoplasmic reticulum membraneCytoplasmic vesicle, secretory vesicle

VIAS BIOLÓGICAS (2)
Post-translational protein phosphorylationRegulation of Insulin-like Growth Factor (IGF) transport and uptake by Insulin-like Growth Factor Binding Proteins (IGFBPs)
MECANISMO DE DOENÇA

Wolfram syndrome 1

A rare disorder characterized by juvenile-onset insulin-dependent diabetes mellitus with optic atrophy. Other manifestations include diabetes insipidus, sensorineural deafness, dementia, psychiatric illnesses.

EXPRESSÃO TECIDUAL(Ubíquo)
Ovário
209.9 TPM
Útero
191.1 TPM
Aorta
160.6 TPM
Fallopian Tube
157.4 TPM
Artéria tibial
151.6 TPM
OUTRAS DOENÇAS (8)
Wolfram syndrome 1Wolfram-like syndromeautosomal dominant nonsyndromic hearing loss 6cataract 41
HGNC:12762UniProt:O76024

Medicamentos e terapias

VALPROIC ACIDPhase 2

Mecanismo: Succinate semialdehyde dehydrogenase inhibitor

VALPROATE SODIUMPhase 2

Mecanismo: Succinate semialdehyde dehydrogenase inhibitor

TIRZEPATIDEPhase 2

Mecanismo: Gastric inhibitory polypeptide receptor agonist

DANTROLENE SODIUMPhase 1

Mecanismo: Ryanodine receptor 1 antagonist

DANTROLENEPhase 1

Mecanismo: Ryanodine receptor 1 antagonist

Ver mais no OpenTargets

Variantes genéticas (ClinVar)

753 variantes patogênicas registradas no ClinVar.

🧬 CISD2: NM_001008388.5(CISD2):c.109G>T (p.Glu37Ter) ()
🧬 CISD2: NC_000004.11:g.(?_101947022)_(104640852_?)del ()
🧬 CISD2: NC_000004.11:g.(?_103790242)_(103806607_?)del ()
🧬 CISD2: GRCh37/hg19 4q23-25(chr4:100172302-107880077)x1 ()
🧬 CISD2: GRCh37/hg19 4q24-35.2(chr4:101203509-190957473)x3 ()
Ver todas no ClinVar

Classificação de variantes (ClinVar)

Distribuição de 940 variantes classificadas pelo ClinVar.

235
705
Patogênica (25.0%)
VUS (75.0%)
VARIANTES MAIS SIGNIFICATIVAS
WFS1: NM_006005.3(WFS1):c.358G>T (p.Glu120Ter) [Likely pathogenic]
WFS1: NM_006005.3(WFS1):c.517G>T (p.Glu173Ter) [Likely pathogenic]
WFS1: NM_006005.3(WFS1):c.762C>G (p.Tyr254Ter) [Pathogenic]
WFS1: NM_006005.3(WFS1):c.2095A>C (p.Thr699Pro) [Likely pathogenic]
WFS1: NM_006005.3(WFS1):c.863T>G (p.Val288Gly) [Likely pathogenic]

Diagnóstico

Os sinais que médicos procuram e os exames que confirmam

Carregando...

Tratamento e manejo

Remédios, cuidados de apoio e o que precisa acompanhar

Pipeline de tratamentos
Pipeline regulatório — de medicamentos já aprovados a drogas em pesquisa exploratória.
2Fase 28
1Fase 12
·Pré-clínico7
Medicamentos catalogadosEnsaios clínicos· 5 medicamentos · 12 ensaios
Carregando informações de tratamento...

Onde tratar no SUS

Hospitais de referência no Brasil e o protocolo oficial do SUS (PCDT)

🇧🇷 Atendimento SUS — Síndrome Wolfram

🗺️

Selecione um estado ou use sua localização para ver resultados.

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

🟢 Recrutando agora

2 pesquisas recrutando participantes. Converse com seu médico sobre a possibilidade de participar.

Outros ensaios clínicos

14 ensaios clínicos encontrados, 6 ativos.

Distribuição por fase
Ver todos no ClinicalTrials.gov
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Publicações mais relevantes

🥇Melhor nível de evidência: Revisão sistemática
Timeline de publicações
436 papers (10 anos)
#1

The Neuroradiologic Spectrum of Wolfram Syndrome.

Annals of Indian Academy of Neurology2026 Jan 01
#2

Optic Atrophy in Wolfram Syndrome Type 1: A Retrospective Analysis of Visual Outcomes and Biomarker Correlates.

Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society2026 Mar 24

Wolfram syndrome type 1 (WS1) is a rare autosomal recessive disorder classically associated with diabetes mellitus (DM) and optic atrophy (OA). We aimed to characterize OA in WS1 and evaluate optical coherence tomography (OCT) and genetic biomarkers as tools for disease monitoring and prognostication. We conducted a retrospective chart review of genetically confirmed patients with WS1 seen at Washington University or Indiana University neuro-ophthalmology clinics between July 2017 and 2024. Data included demographics, clinical history, best corrected visual acuity (BCVA), OCT retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness, and WFS1 mutation severity scores. Linear regression analyses assessed correlations between BCVA and clinical, structural, and genetic variables. Thirty-six patients (22 women, 14 men; median age 20 years) were identified. Median mutation severity score was 3.5. Vision loss occurred in 31 patients; in 3 patients it was the only major symptom, in 5 patients it preceded DM, and in 6 patients it occurred without DM. Mean and median BCVA were 20/125 and 20/80, respectively. BCVA correlated inversely with RNFL thickness (P = 0.0017, R2 = 0.14), GCC thickness (P = 0.0018, R2 = 0.29), and mutation severity score (P = 0.031, R2 = 0.14). OA was the most common and sometimes earliest WS1 manifestation. Correlations between BCVA, OCT metrics, and mutation severity score support their potential value as biomarkers and prognostic tools. Findings also support considering genetic screening for WFS1 mutations in patients presenting with otherwise unexplained OA.

#3

Ophthalmic, Systemic and Genetic Features in Wolfram Syndrome.

Neuro-ophthalmology (Aeolus Press)2026

To evaluate quantitative microvascular ocular features using optical coherence tomography angiography (OCTA) in patients with Wolfram syndrome (WFS) and compared it with healthy controls. This cross-sectional study included patients with WFS and healthy controls. Diagnosis of WFS was based on clinical presentation and identification of biallelic pathogenic variants in the WFS1 gene. Ophthalmic and systemic examinations were performed. Spectral Domain OCTA scans of the optic nerve head (ONH), peripapillary region, and macular area were analyzed in patients able to undergo the exam and compared to controls. Fifty-seven eyes were included: 22 eyes from 11 WFS patients and 35 eyes from 18 healthy controls, from six families with WFS. Optic atrophy (100%) and diabetes mellitus (90.9%) were the most common systemic findings, followed by neurologic, urologic, and psychiatric disorders (each 63.6%), neurosensorial deafness (54.5%), and diabetes insipidus (9.1%). Best-corrected visual acuity ranged from light perception to 0.1 logMAR, with a mean of 0.97 ± 0.69 logMAR. OCTA analysis revealed significantly lower whole-image vessel density (VD), inside-disc VD, and peripapillary VD in WFS patients compared to controls (p < .001). The macular region showed significantly reduced parafoveal superficial capillary plexus (SCP) vessel density (p < .001). Sectoral analysis showed decreased parafoveal SCP VD in the nasal, inferior, and superior sectors (p < .001). WFS is a progressive neurodegenerative disorder with severe ocular and systemic manifestations. OCTA demonstrated reduced vessel density in all examined regions in WFS patients, suggesting microvascular impairment may contribute to neurodegeneration and structural retinal changes.

#4

Routine Fundoscopy Uncovering Wolfram Syndrome in a Diabetic Patient: A Case Report.

Cureus2026 Jan

Wolfram syndrome is a rare inherited neurodegenerative disorder, in which early ophthalmologic abnormalities may provide the initial diagnostic clue. In this article, we report the case of a 20-year-old male with early-onset bilateral deafness and insulin-dependent diabetes mellitus who was referred for evaluation of possible diabetic retinopathy. He reported no visual complaints at the time of presentation. Examination showed a visual acuity of 2/10 bilaterally, and optic disc pallor on fundoscopy without diabetic retinopathy. Further complementary testing revealed diffuse visual field defects and marked retinal nerve fiber layer (RNFL) thinning on optical coherence tomography (OCT), consistent with optic atrophy. Neuroimaging showed posterior pituitary agenesis, and subsequent endocrine evaluation confirmed diabetes insipidus. Taken together with the patient's sensorineural deafness and diabetes mellitus, these findings strongly supported the diagnosis of Wolfram syndrome. Genetic testing was advised but not performed due to financial limitations. Ophthalmic management consisted of vitamin supplementation, low-vision rehabilitation, and scheduled follow-up. Given the multisystemic nature of the disease, multidisciplinary follow-up was implemented. This case emphasizes the importance of broad systemic workup in young individuals with atypical ocular findings and highlights Wolfram syndrome as a key differential diagnosis when optic atrophy is accompanied by hearing loss or diabetes mellitus.

#5

Gonadal function in males with WFS1 spectrum disorder (Wolfram syndrome)-A European cohort perspective.

Andrology2026 Feb

WFS1 spectrum disorder, also known as Wolfram syndrome (WS) is an ultra-rare (<1:500,000; ORPHA: 3463) monogenic (OMIM #222300) progressive neuroendocrine and neurodegenerative disorder, characterised by early-onset insulin-dependent diabetes, optic atrophy, central diabetes insipidus and sensi-neuronal deafness. It is caused predominantly by bi-allelic mutations in the WFS1 gene and exceptionally in the WFS2-gene. There is very limited published data on gonadal function in young people with WS. Expansion of the phenotype has previously included suggestions of abnormalities in puberty in adolescents with (WS) but with little detail.1-3 AIM: To assess testicular function and pubertal progression in a cohort of adolescent and young adult patients with classical WFS1 spectrum disorder (WS). Retrospective case notes review of national patient cohorts comprising 21 males with WS aged 16-30 years. All patients were treated in two tertiary European health care centres: in Birmingham, UK and Münster, Germany. Hormonal parameters reflecting hypothalamic-pituitary-gonadal axis function and treatment with sex hormones were assessed. In addition, the presence or absence of erectile dysfunction was explored. In a subset of men, semen data were analysed. In one young man, testicular biopsies were examined histologically using light and electron microscopy. Severely delayed or arrested puberty was observed in 57% of male adolescents with WS, necessitating testosterone replacement for completion of pubertal development. Subclinical (compensated) hypergonadotropic hypogonadism with still adequate testosterone serum concentration for age, but elevated LH/FSH was observed in 28.6% (n = 6). In two males, aged 19 and 16 years (9.5%), inadequately low LH/FSH and testosterone levels indicated hypogonadotropic hypogonadism. In the subset of males with normal puberty and normal endocrine testicular function (43% of male patients), the oldest, aged 30 years had normal sperm count in semen. Another young man had oligozoospermia at age 20, but azoospermia at age 25 years. Histology of his testicular tissues evidenced structural alterations of Leydig and Sertoli cells and tubular atrophy with various stages of tubular degeneration and meiotic arrest of spermatogenesis. Endocrine testicular function and reproductive capacity are impaired in males with WS potentially due to premature degeneration of the testes, with 57% of adolescents developing hypogonadism with pubertal arrest.

Publicações recentes

Ver todas no PubMed

📚 EuropePMC551 artigos no totalmostrando 197

2026

Optic Atrophy in Wolfram Syndrome Type 1: A Retrospective Analysis of Visual Outcomes and Biomarker Correlates.

Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society
2026

Ophthalmic, Systemic and Genetic Features in Wolfram Syndrome.

Neuro-ophthalmology (Aeolus Press)
2026

Routine Fundoscopy Uncovering Wolfram Syndrome in a Diabetic Patient: A Case Report.

Cureus
2025

Genomic Insights into Unspecified Monogenic Forms of Diabetes and Their Associated Comorbidities: Implication for Treatment.

Current issues in molecular biology
2025

A novel heterozygous WFS1 variant of uncertain significance in a patient with early-onset diabetes: a case report.

Frontiers in endocrinology
2025

Pridopidine, a Potent and Selective Therapeutic Sigma-1 Receptor (S1R) Agonist for Treating Neurodegenerative Diseases.

Pharmaceuticals (Basel, Switzerland)
2025

Phenotype Correlations of Neurological Manifestations in Wolfram Syndrome: Predictive Modeling in a Spanish Cohort.

Diagnostics (Basel, Switzerland)
2025

Optic Atrophy Predominant WFS1 Disorder-A Case-Control Study.

Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society
2026

The Neuroradiologic Spectrum of Wolfram Syndrome.

Annals of Indian Academy of Neurology
2025

Hyperglycemic Hyperosmolar State as the Initial Presentation of Wolfram Syndrome: A Common Complication Revealing a Rare Disease-A Case Report.

Clinical case reports
2025

A Rare Case of Wolfram Syndrome in a 27-Year-Old Male From Nepal.

Cureus
2025

CISD2 ensures adequate ER-mitochondrial coupling, critically supporting mitochondrial function in neurons.

Acta neuropathologica communications
2025

Expanding the spectrum of white matter abnormalities in Wolfram syndrome: a retrospective review.

Frontiers in neurology
2025

Wolfram syndrome: A perspective on gene editing as a therapeutic strategy.

Neural regeneration research
2026

Neutropenia Through Enhanced Neutrophil Apoptosis and Secondary Necrosis in Wolfram Syndrome 1.

Turkish journal of haematology : official journal of Turkish Society of Haematology
2025

Enhancing the diagnostic yield of monogenic diabetes in unresolved cases with early-onset hyperglycemia.

Communications medicine
2025

Transitioning adolescents with rare forms of diabetes to adult care: challenges and perspectives.

Endocrine connections
2025

Diabetes Insipidus as an Early Clinical Indicator of Wolfram Syndrome Type 1: Evidence From a Symptom-Based Screening Approach.

Pediatric diabetes
2025

Wolfram-like Syndrome: Shedding Light on a Variant of Wolfram Syndrome.

AACE endocrinology and diabetes
2025

Circadian Rhythm and Psychiatric Features in Wolfram Syndrome: Toward Chrono Diagnosis and Chronotherapy.

Diagnostics (Basel, Switzerland)
2025

Case Report: Rapid cataract development preceding diabetes mellitus in WFS1 spectrum disorder.

Frontiers in ophthalmology
2025

Diabetes mellitus and pregnancy in Wolfram syndrome type 1: a case report with review of clinical and pathophysiological aspects.

Frontiers in medicine
2025

Clinical Research for Inherited Retinal Disease Related Pediatric Blindness: A Preliminary Descriptive Analysis Based on ClinicalTrials.gov.

Journal of multidisciplinary healthcare
2025

Could R-Ketamine and Wolfram Syndrome Inform Understanding of Depression and Suicidality? A Sigma-1 Receptor-Based Perspective.

Human psychopharmacology
2025

Diabetes and optic atrophy in a young adult: consider Wolfram syndrome.

Practical neurology
2025

WFS1 gene mutation associated with pediatric diabetes mellitus and congenital deafness: A case report.

World journal of diabetes
2025

Localization and connections of the tail of caudate and caudal putamen in mouse brain.

Frontiers in neural circuits
2025

Topology of WFS1 Variants Linked With Islet Function and Higher Risk of Urological Symptoms in WFS1-Associated Disease.

Pediatric diabetes
2025

WFS1 Gene Mutation (c.2389G > A) Induces Immune Disorders by Promoting DC Maturation through Inhibition of TMEM176A.

Inflammation
2025

Long-term follow-up of pancreatic islet transplantation in a patient with Wolfram syndrome: a case report.

Acta diabetologica
2025

Gonadal Dysfunction in Wolfram Syndrome: A Prospective Study.

Diagnostics (Basel, Switzerland)
2025

Characterization of Novel WFS1 Variants in Three Diabetes Pedigrees.

Journal of diabetes
2025

The Labile Side of Iron in Health and Disease: A Narrative Review.

Advances in experimental medicine and biology
2025

Brainstem and optic pathway involvement in wolfram syndrome.

Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
2025

The significance of ophthalmological evaluation in the correct diagnosis of pediatric insulin-dependent diabetes mellitus: lessons from novel WFS1 variants.

Diabetes &amp; metabolism
2025

A case of a young patient with progressive vision loss: An atypical presentation of the rare Wolfram Syndrome in a Middle Eastern individual.

American journal of ophthalmology case reports
2025

A Hidden Diagnosis: Neurogenic Bladder Leading to Acute Kidney Failure in Wolfram Syndrome.

Cureus
2025

Profile of monogenic diabetes: a Pan-India study.

Diabetes research and clinical practice
2025

Proteomic profiling of pseudorabies virus-infected PK-15 cells based on 4D label free analysis.

Veterinary research forum : an international quarterly journal
2025

Clinical trials for Wolfram syndrome neurodegeneration: Novel design, endpoints, and analysis models.

PloS one
2025

Isolated and Syndromic Genetic Optic Neuropathies: A Review of Genetic and Phenotypic Heterogeneity.

International journal of molecular sciences
2026

Gonadal function in males with WFS1 spectrum disorder (Wolfram syndrome)-A European cohort perspective.

Andrology
2025

Improving mitochondria-associated endoplasmic reticulum membranes integrity as converging therapeutic strategy for rare neurodegenerative diseases and cancer.

Biochimica et biophysica acta. Molecular cell research
2025

Liraglutide Treatment Reverses Unconventional Cellular Defects in Induced Pluripotent Stem Cell-Derived β-Cells Harboring a Partially Functional WFS1 Variant.

Diabetes
2025

Wolfram syndrome 2 gene (CISD2) deficiency disrupts Ca2+-mediated insulin secretion in β-cells.

Molecular metabolism
2025

Reciprocal rescue of Wolfram syndrome by two causative genes.

EMBO reports
2025

Nuclear factor erythroid 2-related factor improves depression and cognitive dysfunction in rats with ischemic stroke by mediating wolfram syndrome 1.

Brain research
2025

Natural history of patients with autosomal dominant WFS1 pathogenic variants associated with sensorineural hearing loss and optic atrophy.

medRxiv : the preprint server for health sciences
2025

GABA and GLP-1 receptor agonist combination therapy modifies diabetes and Langerhans islet cytoarchitecture in a rat model of Wolfram syndrome.

Diabetology &amp; metabolic syndrome
2025

Sodium valproate, a potential repurposed treatment for the neurodegeneration in Wolfram syndrome (TREATWOLFRAM): trial protocol for a pivotal multicentre, randomised double-blind controlled trial.

BMJ open
2025

β cell dedifferentiation, the underlying mechanism of diabetes in Wolfram syndrome.

Science translational medicine
2025

Identification of a pathogenic founder variant in the WFS1 gene that causes Wolfram syndrome in the Druze population.

Frontiers in pediatrics
2025

The Role of Visual Electrophysiology in Systemic Hereditary Syndromes.

International journal of molecular sciences
2025

Do wolframin, P-glycoprotein, and GRP78/BiP cooperate to alter the response of L1210 cells to endoplasmic reticulum stress or drug sensitivity?

Cancer cell international
2025

The Heterozygous p.A684V Variant in the WFS1 Gene Is a Mutational Hotspot Causing a Severe Hearing Loss Phenotype.

Genes
2025

A Rare Case of Wolfram Syndrome Presenting With Tuberculous Meningitis: A Case Report.

Clinical case reports
2024

Patients with a Wide Range of Disorders Related to WFS1 Gene Variants: Novel Mutations and Genotype-Phenotype Correlations.

Genes
2024

Cochlear implant in Wolfram syndrome: A case report.

Cochlear implants international
2025

Foecal incontinence disorders in Wolfram syndrome: a new manifestation.

Journal of medical genetics
2024

Dual role of neuroplastin in pancreatic β cells: Regulating insulin secretion and promoting islet inflammation.

Proceedings of the National Academy of Sciences of the United States of America
2025

Early trigeminal and sensory impairment and lysosomal dysfunction in accurate models of Wolfram syndrome.

Experimental neurology
2025

Novel Presentation of Type 1 Wolfram Syndrome as Intracranial Hemorrhage and Longitudinally Extensive Transverse Myelitis: Neuroimaging and Angiographic Findings.

Annals of Indian Academy of Neurology
2024

A NOVEL DE NOVO LIKELY PATHOGENIC VARIANT OF WFS-1 GENE IN A PAKISTANI CHILD WITH NON-CLASSIC WFS-1 SPECTRUM DISORDER.

Journal of Ayub Medical College, Abbottabad : JAMC
2024

Beyond Wolfram Syndrome 1: The WFS1 Gene's Role in Alzheimer's Disease and Sleep Disorders.

Biomolecules
2025

The phenotypic spectrum of syndromic optic atrophy associated with variants in WFS1: with reclassification of p.Val606Gly as a likely benign variant.

Ophthalmic genetics
2025

SID/SIEDP expert consensus on optimizing clinical strategies for early detection and management of wolfram syndrome.

Journal of endocrinological investigation
2025

A WFS1 variant disrupting acceptor splice site uncovers the impact of alternative splicing on beta cell apoptosis in a patient with Wolfram syndrome.

Diabetologia
2024

Defects of WFS1-mediated peptide hormones secretion contribute to the manifestations of Wolfram syndrome.

Life sciences
2025

Tale of mitochondria and mitochondria-associated ER membrane in patient-derived neuronal models of Wolfram syndrome.

Neural regeneration research
2024

A novel (-)-(2S)-7,4'-dihydroxyflavanone compound for treating age-related diabetes mellitus through immunoinformatics-guided activation of CISD3.

Biogerontology
2025

Good cochlear implantation outcomes in subjects with mono-allelic WFS1-associated sensorineural hearing loss - a case series.

International journal of audiology
2024

Insights from a Wolfram syndrome cohort: clinical and molecular findings from a specialized diabetes reference center.

Archives of endocrinology and metabolism
2024

OBSESSIVE COMPULSIVE DISORDER AND CONSTITUTIONAL DELAY OF GROWTH AND PUBERTY IN WOLFRAM SYNDROME: NEW ASPECTS AND A NOVEL WFS1 MUTATION.

Acta endocrinologica (Bucharest, Romania : 2005)
2025

CISD2 counteracts the inhibition of ER-mitochondrial calcium transfer by anti-apoptotic BCL-2.

Biochimica et biophysica acta. Molecular cell research
2024

Characteristics of autosomal dominant WFS1-associated optic neuropathy and its comparability to OPA1-associated autosomal dominant optic atrophy.

Scientific reports
2024

Early presentation of urological abnormalities in a case of Wolfram syndrome.

BMJ case reports
2024

Images in sleep medicine sleep-disordered breathing in Wolfram's syndrome - A near-fatal event.

Sleep medicine
2024

Endoplasmic reticulum-mitochondria lockdown in Wolfram syndrome.

Cell calcium
2024

Novel WFS1 variants are associated with different diabetes phenotypes.

Frontiers in genetics
2024

Wolfram Syndrome 1: A Neuropsychiatric Perspective on a Rare Disease.

Genes
2024

Clinical Characteristics and Audiological Profiles of Patients with Pathogenic Variants of WFS1.

Journal of clinical medicine
2024

A deep phenotyping study in mouse and iPSC models to understand the role of oligodendroglia in optic neuropathy in Wolfram syndrome.

Acta neuropathologica communications
2024

Immunoinformatic-based drug design utilizing hesperetin to target CISD2 activation for liver aging in humans.

Biogerontology
2024

Beyond Vision and Hearing: A Case Report of Wolfram Syndrome.

Cureus
2024

Continuous glycemic monitoring in managing diabetes in adult patients with wolfram syndrome.

Acta diabetologica
2025

Family Planning in Genetic Optic Atrophies in Israel, a Case Series and a Discussion of Ethical Considerations.

Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society
2024

Wolfram Syndrome Type I Case Report and Review-Focus on Early Diagnosis and Genetic Variants.

Medicina (Kaunas, Lithuania)
2024

ER calcium depletion as a key driver for impaired ER-to-mitochondria calcium transfer and mitochondrial dysfunction in Wolfram syndrome.

Nature communications
2024

Identification of unique cell type responses in pancreatic islets to stress.

Nature communications
2024

Sequential Presentation of Obsessive-Compulsive Disorder and Narcolepsy in a 10-Year-Old Girl With Wolfram Syndrome 1.

The Journal of nervous and mental disease
2025

Optic Nerve T2 Signal Intensity and Caliber Reflect Clinical Severity in Genetic Optic Atrophy.

Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society
2024

An adolescent male with persistent urinary symptoms.

Pediatric nephrology (Berlin, Germany)
2024

Multimodal imaging in autosomal dominant Wolfram syndrome and long-term follow-up of laminations of the outer plexiform layer.

Eye (London, England)
2024

Novel WFS1 Variants in Two Moroccan Families with Wolfram Syndrome.

Genetic testing and molecular biomarkers
2024

The Wolfram-like variant WFS1E864K destabilizes MAM and compromises autophagy and mitophagy in human and mice.

Autophagy
2024

Astrocyte-mediated regulation of BLAWFS1 neurons alleviates risk-assessment deficits in DISC1-N mice.

Neuron
2024

Cisd2 deficiency impairs neutrophil function by regulating calcium homeostasis via Calnexin and SERCA.

BMB reports
2024

Cardiac Wolframinopathies: A Case Report of Myocarditis and a Literature Review of Cardiac Involvement in Wolfram Syndrome 1.

Journal of clinical medicine
2024

A Wolfram-like syndrome family: Case report.

European journal of ophthalmology
2024

Long term clinical follow up of four patients with Wolfram syndrome and urodynamic abnormalities.

Journal of pediatric endocrinology &amp; metabolism : JPEM
2024

An adolescent with Wolfram syndrome and central sleep apnea.

Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
2024

Comprehensive overview of disease models for Wolfram syndrome: toward effective treatments.

Mammalian genome : official journal of the International Mammalian Genome Society
2024

ISR inhibition reverses pancreatic β-cell failure in Wolfram syndrome models.

Cell death and differentiation
2024

[Wolfram-like syndrome: a case report].

[Zhonghua yan ke za zhi] Chinese journal of ophthalmology
2024

Neuroimaging features in Wolfram syndrome type 1.

Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
2023

Whole-exome sequencing reveals novel variants of monogenic diabetes in Tunisia: impact on diagnosis and healthcare management.

Frontiers in genetics
2024

Overlap between ophthalmology and psychiatry - A narrative review focused on congenital and inherited conditions.

Psychiatry research
2024

Convolamine, a tropane alkaloid extracted from Convolvulus plauricalis, is a potent sigma-1 receptor-positive modulator with cognitive and neuroprotective properties.

Phytotherapy research : PTR
2023

Wolfram syndrome type 1: a case series.

Orphanet journal of rare diseases
2024

High Frequency of Recessive WFS1 Mutations Among Indian Children With Islet Antibody-negative Type 1 Diabetes.

The Journal of clinical endocrinology and metabolism
2023

Wolfram Syndrome: A Curious Case of Repetitive Loss of Consciousness.

Cureus
2023

Treatment with the dual-incretin agonist DA-CH5 demonstrates potent therapeutic effect in a rat model of Wolfram Syndrome.

Frontiers in endocrinology
2023

The miR-668 binding site variant rs1046322 on WFS1 is associated with obesity in Southeast Asians.

Frontiers in endocrinology
2024

Dopamine D2 receptors in WFS1-neurons regulate food-seeking and avoidance behaviors.

Progress in neuro-psychopharmacology &amp; biological psychiatry
2023

Genomics of Wolfram Syndrome 1 (WFS1).

Biomolecules
2023

Next generation sequencing identifies a pathogenic mutation of WFS1 gene in a Moroccan family with Wolfram syndrome: a case report.

Journal of medical case reports
2023

Variants of WFS1 identified by whole exome sequencing in a boy with Wolfram syndrome 1: A case report.

Biomedical reports
2023

Wolfram Syndrome-2, a Cause of Severe Gastrointestinal Bleeding: A Case Series and a Literature Review.

JPGN reports
2024

Wolfram Syndrome: Only a Neurodegenerative Disease or Also a Maculopathy?

Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society
2023

There's More Than Meets the Eye: Wolfram Syndrome in a Type I Diabetic Patient.

Journal of medical cases
2023

Wolfram Syndrome 1 in Two Brothers Treated with Insulin Pump.

AACE clinical case reports
2023

Neuro-Ophthalmologic Variability in Presentation of Genetically Confirmed Wolfram Syndrome: A Case Series and Review.

Brain sciences
2023

Neurosensory Affectation in Patients Affected by Wolfram Syndrome: Descriptive and Longitudinal Analysis.

Healthcare (Basel, Switzerland)
2023

Selective proteasome degradation of C-terminally-truncated human WFS1 in pancreatic beta cells.

FEBS open bio
2023

Genotype and clinical characteristics of patients with Wolfram syndrome and WFS1-related disorders.

Frontiers in genetics
2023

Wolfram syndrome 1 regulates sleep in dopamine receptor neurons by modulating calcium homeostasis.

PLoS genetics
2023

Wfs1E864K knock-in mice illuminate the fundamental role of Wfs1 in endocochlear potential production.

Cell death &amp; disease
2023

Paediatric Wolfram syndrome Type 1: should gonadal dysfunction be part of the diagnostic criteria?

Frontiers in endocrinology
2023

GLP-1 receptor agonists as promising disease-modifying agents in WFS1 spectrum disorder.

Frontiers in clinical diabetes and healthcare
2022

Repetitive Suicidal Behaviors in a Case With a New Mutation of Wolfram Syndrome: A Jump From the Gene to the Behavior.

Basic and clinical neuroscience
2023

Targeting Ca2+-dependent pathways to promote corneal epithelial wound healing induced by CISD2 deficiency.

Cellular signalling
2023

Peculiar Outer Plexiform Layer in Autosomal Dominant Wolfram Syndrome.

Ophthalmology. Retina
2023

The genetic and clinical characteristics of WFS1 related diabetes in Chinese early onset type 2 diabetes.

Scientific reports
2023

Next Generation Sequencing (NGS) Target Approach for Undiagnosed Dysglycaemia.

Life (Basel, Switzerland)
2023

Clinical management and obstetric outcome in WFS1 Wolfram syndrome spectrum disorder: A case report and literature review.

Taiwanese journal of obstetrics &amp; gynecology
2023

Depletion of WFS1 compromises mitochondrial function in hiPSC-derived neuronal models of Wolfram syndrome.

Stem cell reports
2023

Chronic Stress Alters Hippocampal Renin-Angiotensin-Aldosterone System Component Expression in an Aged Rat Model of Wolfram Syndrome.

Genes
2023

Rescue of Long-Term Spatial Memory by 7,8-Dihydroxyflavone in Mice with Reduced Oligodendrogenesis.

eNeuro
2023

GLP1 receptor agonists for Wolfram syndrome?

Nature reviews. Endocrinology
2023

WFS1 autosomal dominant variants linked with hearing loss: update on structural analysis and cochlear implant outcome.

BMC medical genomics
2023

Wfs1 loss-of-function disrupts the composition of mouse pancreatic endocrine cells from birth and impairs Glut2 localization to cytomembrane in pancreatic β cells.

Biochemical and biophysical research communications
2023

GLP-1R agonists demonstrate potential to treat Wolfram syndrome in human preclinical models.

Diabetologia
2023

Evaluation of the Oral Bacterial Genome and Metabolites in Patients with Wolfram Syndrome.

International journal of molecular sciences
2023

Generation of induced pluripotent stem cells (IBMSi027-A) from a patient with hearing loss carrying WFS1 c.2051C > T (p.Ala684Val) variant.

Stem cell research
2023

Wolfram Syndrome 1: A Pediatrician's and Pediatric Endocrinologist's Perspective.

International journal of molecular sciences
2023

Case Report: A novel mutation in WFS1 gene (c.1756G>A p.A586T) is responsible for early clinical features of cognitive impairment and recurrent ischemic stroke.

Frontiers in genetics
2023

Enhancement of taste by retronasal odors in patients with Wolfram syndrome and decreased olfactory function.

Chemical senses
2023

[Advances in diagnosis and treatment of Wolfram syndrome and related molecular mechanism].

Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine]
2023

A novel WFS1 variant associated with isolated congenital cataracts.

Cold Spring Harbor molecular case studies
2023

Coupling of autophagy and the mitochondrial intrinsic apoptosis pathway modulates proteostasis and ageing in Caenorhabditis elegans.

Cell death &amp; disease
2023

Delineating Wolfram-like syndrome: A systematic review and discussion of the WFS1-associated disease spectrum.

Survey of ophthalmology
2023

Modeling disrupted synapse formation in wolfram syndrome using hESCs-derived neural cells and cerebral organoids identifies Riluzole as a therapeutic molecule.

Molecular psychiatry
2022

β-cyclodextrin based nano gene delivery using pharmaceutical applications to treat Wolfram syndrome.

Therapeutic delivery
2023

Endoplasmic reticulum stress inhibition ameliorated WFS1 expression alterations and reduced pancreatic islets' insulin secretion induced by high-fat diet in rats.

Scientific reports
2022

Psychiatric Diagnoses and Medications in Wolfram Syndrome.

Scandinavian journal of child and adolescent psychiatry and psychology
2023

MCT1-dependent energetic failure and neuroinflammation underlie optic nerve degeneration in Wolfram syndrome mice.

eLife
2023

A Pair of Siblings With Wolfram Syndrome: A Review of the Literature and Treatment Options.

Journal of investigative medicine high impact case reports
2023

Predictions of the Poses and Affinity of a Ligand over the Entire Surface of a NEET Protein: The Case of Human MitoNEET.

Journal of chemical information and modeling
2022

The Role of ER Stress in Diabetes: Exploring Pathological Mechanisms Using Wolfram Syndrome.

International journal of molecular sciences
2022

A 75-Year-Old Woman with a 5-Year History of Controlled Type 2 Diabetes Mellitus Presenting with Polydipsia and Polyuria and a Diagnosis of Central Diabetes Insipidus.

The American journal of case reports
2023

New unexpected role for Wolfram Syndrome protein WFS1: a novel therapeutic target for Alzheimer's disease?

Neural regeneration research
2022

Wolfram syndrome 1b mutation suppresses Mauthner-cell axon regeneration via ER stress signal pathway.

Acta neuropathologica communications
2022

Rejuvenation: Turning Back Time by Enhancing CISD2.

International journal of molecular sciences
2022

NCS1 overexpression restored mitochondrial activity and behavioral alterations in a zebrafish model of Wolfram syndrome.

Molecular therapy. Methods &amp; clinical development
2022

[Two cases of Wolfram syndrome].

[Zhonghua yan ke za zhi] Chinese journal of ophthalmology
2022

Multidimensional analysis and therapeutic development using patient iPSC-derived disease models of Wolfram syndrome.

JCI insight
2022

Wolfram syndrome in a young woman with associated hypergonadotropic hypogonadism - A case report.

Journal of pediatric endocrinology &amp; metabolism : JPEM
2022

Comprehensive Genetic Analysis Unraveled the Missing Heritability in a Chinese Cohort With Wolfram Syndrome 1: Clinical and Genetic Findings.

Investigative ophthalmology &amp; visual science
2023

A novel WFS1 variant associated with severe diabetic retinopathy in Wolfram syndrome type 1.

Ophthalmic genetics
2022

Oxidative and endoplasmic reticulum stress develop adverse metabolic effects due to the high-fat high-fructose diet consumption from birth to young adulthood.

Life sciences
2024

Early Diagnosis of Wolfram Syndrome by Ophthalmologic Screening in a Patient with Type 1B Diabetes Mellitus: A Case Report.

Journal of clinical research in pediatric endocrinology
2022

Petrified heart in a patient with Wolfram Syndrome.

Journal of public health research
2022

Longitudinal Changes in Vision and Retinal Morphology in Wolfram Syndrome.

American journal of ophthalmology
2022

[Genetic and prenatal diagnosis of a Chinese pedigree with autosomal recessive Wolfram syndrome 1 due to compound heterozygous variants of WFS1 gene].

Zhonghua yi xue yi chuan xue za zhi = Zhonghua yixue yichuanxue zazhi = Chinese journal of medical genetics
2022

Wolfram syndrome with a rare genetic mutation - Case report.

Indian journal of ophthalmology
2022

Diabetes Out-of-the-Box: Diabetes Mellitus and Impairment in Hearing and Vision.

Current diabetes reports
2022

Dysregulated Ca2+ Homeostasis as a Central Theme in Neurodegeneration: Lessons from Alzheimer's Disease and Wolfram Syndrome.

Cells
2022

Two Cases of Wolfram Syndrome Who Were Initially Diagnosed With Type 1 Diabetes.

AACE clinical case reports
2022

Plasma Neurofilament Light Chain Levels Are Elevated in Children and Young Adults With Wolfram Syndrome.

Frontiers in neuroscience
2022

Neuro-ophthalmological manifestations of Wolfram syndrome: Case series and review of the literature.

Journal of the neurological sciences
2022

The Pattern of Retinal Ganglion Cell Loss in Wolfram Syndrome is Distinct From Mitochondrial Optic Neuropathies.

American journal of ophthalmology
2022

Novel missense WFS1 variant causing autosomal dominant atypical Wolfram syndrome.

Ophthalmic genetics
2022

Loss of Function of WFS1 Causes ER Stress-Mediated Inflammation in Pancreatic Beta-Cells.

Frontiers in endocrinology
2022

Boosting ER-mitochondria calcium transfer to treat Wolfram syndrome.

Cell calcium
2022

Wolfram Syndrome 1: From Genetics to Therapy.

International journal of environmental research and public health
2022

Morphological, behavioral and cellular analyses revealed different phenotypes in Wolfram syndrome wfs1a and wfs1b zebrafish mutant lines.

Human molecular genetics
2022

[Genetic protocol in primary care for rare diseases: Wolfram syndrome as a prototype].

Atencion primaria
2022

Wolframin deficiency is accompanied with metabolic inflexibility in rat striated muscles.

Biochemistry and biophysics reports
2022

Metabolic Treatment of Wolfram Syndrome.

International journal of environmental research and public health
2022

Wolfram syndrome: Phenotypic heterogeneity and novel genetic variants in the WFS1 gene.

Endocrinologia, diabetes y nutricion
2022

Wolfram Syndrome: A case report of two sisters Wolfram Syndrome: Case report of two sisters.

American journal of ophthalmology case reports
2021

Recurrent Urinary Tract Infection in Young Diabetics: Reason to Look Beyond the Pancreas!

Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia
2022

Compound genetic etiology in a patient with a syndrome including diabetes, intellectual deficiency and distichiasis.

Orphanet journal of rare diseases
2022

An Atypical Case of Late-Onset Wolfram Syndrome 1 without Diabetes Insipidus.

International journal of environmental research and public health
2022

Activation of the sigma-1 receptor chaperone alleviates symptoms of Wolfram syndrome in preclinical models.

Science translational medicine
2022

Retinal vascular impairment in Wolfram syndrome: an optical coherence tomography angiography study.

Scientific reports
2022

A case of adult-onset Wolfram syndrome with compound heterozygous mutations of the WFS1 gene.

American journal of ophthalmology case reports
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Doenças relacionadas

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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.

  1. The Neuroradiologic Spectrum of Wolfram Syndrome.
    Annals of Indian Academy of Neurology· 2026· PMID 41355012mais citado
  2. Optic Atrophy in Wolfram Syndrome Type 1: A Retrospective Analysis of Visual Outcomes and Biomarker Correlates.
    Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society· 2026· PMID 41870390mais citado
  3. Ophthalmic, Systemic and Genetic Features in Wolfram Syndrome.
    Neuro-ophthalmology (Aeolus Press)· 2026· PMID 41847277mais citado
  4. Routine Fundoscopy Uncovering Wolfram Syndrome in a Diabetic Patient: A Case Report.
    Cureus· 2026· PMID 41684990mais citado
  5. Gonadal function in males with WFS1 spectrum disorder (Wolfram syndrome)-A European cohort perspective.
    Andrology· 2026· PMID 40297921mais citado
  6. Evaluating the Use of GLP-1 Receptor Agonists in Wolfram syndrome Patients.
    medRxiv· 2026· PMID 41959758recente
  7. Type 2 Diabetes Mellitus or Maturity Onset Diabetes in the Young Due to Wolfram Syndrome Gene-1 Mutation-A Perplexing Case.
    AACE Endocrinol Diabetes· 2026· PMID 41938311recente
  8. Medicinal Chemistry Review of the NEET Protein Family.
    ChemMedChem· 2026· PMID 41932344recente
  9. Neurofilament light chain but not glial fibrillary acidic protein serum levels are elevated in Wolfram syndrome.
    Front Neurosci· 2026· PMID 41929703recente
  10. Genotype-Based Severity Scoring System in Wolfram Syndrome: Correlation with Onset of Cardinal Symptoms and WFS1 Gene Variant Types.
    medRxiv· 2026· PMID 41929334recente

Bases de dados e fontes oficiais

Identificadores e referências canônicas usadas para montar este verbete.

  1. ORPHA:3463(Orphanet)
  2. MONDO:0018105(MONDO)
  3. GARD:7898(GARD (NIH))
  4. Variantes catalogadas(ClinVar)
  5. Busca completa no PubMed(PubMed)
  6. Q1153641(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

Síndrome Wolfram
Compêndio · Raras BR

Síndrome Wolfram

ORPHA:3463 · MONDO:0018105
Prevalência
1-9 / 1 000 000
Herança
Autosomal recessive
CID-10
E34.8 · Outros transtornos endócrinos especificados
CID-11
Ensaios
6 ativos
Medicamentos
5 registrados
Início
Adolescent, Adult, Childhood
Prevalência
0.13 (United Kingdom)
MedGen
UMLS
C0043207
EuropePMC
Wikidata
Papers 10a
Evidência
🥇 Rev. sistemática
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