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Link to original content: https://dx.doi.org/10.1038/ncpneuro0421
X-linked adrenoleukodystrophy | Nature Reviews Neurology
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X-linked adrenoleukodystrophy

Nature Clinical Practice Neurology volume 3, pages 140–151 (2007)Cite this article

An Article Report to this article was published on 01 March 2007

An Article Report to this article was published on 01 March 2007

Abstract

X-linked adrenoleukodystrophy (X-ALD) is caused by a defect in the gene ABCD1, which maps to Xq28 and codes for a peroxisomal membrane protein that is a member of the ATP-binding cassette transporter superfamily. X-ALD is panethnic and affects approximately 1:20,000 males. Phenotypes include the rapidly progressive childhood, adolescent, and adult cerebral forms; adrenomyeloneuropathy, which presents as slowly progressive paraparesis in adults; and Addison disease without neurologic manifestations. These phenotypes are frequently misdiagnosed, respectively, as attention-deficit hyperactivity disorder (ADHD), multiple sclerosis, or idiopathic Addison disease. Approximately 50% of female carriers develop a spastic paraparesis secondary to myelopathic changes similar to adrenomyeloneuropathy. Assays of very long chain fatty acids in plasma, cultured chorion villus cells and amniocytes, and mutation analysis permit presymptomatic and prenatal diagnosis, as well as carrier identification. The timely use of these assays is essential for genetic counseling and therapy. Early diagnosis and treatment can prevent overt Addison disease, and significantly reduce the frequency of the severe childhood cerebral phenotype. A promising new method for mass newborn screening has been developed, the implementation of which will have a profound effect on the diagnosis and therapy of X-ALD.

Key Points

  • X-linked adrenoleukodystrophy (X-ALD) is characterized by elevated levels of very long chain fatty acids, which occur secondary to defects in peroxisome β-oxidation associated with mutations in the ABCD1 gene

  • X-ALD is characterized by variable phenotypes affecting the nervous system and the adrenal glands

  • Treatments have focused on lowering levels of very long chain fatty acids using the compound Lorenzo's oil, and hematopoetic stem cell therapy

  • Newborn screening is in development, and this might alter the detection, monitoring and treatment of X-ALD

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Figure 1: Magnetization-weighted imaging of the cervical spinal cord

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Acknowledgements

This work was supported by the Johns Hopkins University School of Medicine General Clinical Research Center grant MO-1-R00052 from the National Center for Research Resources/ National Institutes of Health, Bethesda, MD, and grants HD 39276 and HD 10981 from the National Institutes of Health, Bethesda, MD.

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  1. HW Moser is Professor of Neurology and Pediatrics at Johns Hopkins University, Baltimore, MD, USA and heads the Neurogenetics Research Center at the Kennedy Krieger Institute in Baltimore.,

    Hugo W Moser

  2. A Mahmood is a Research Fellow at the Johns Hopkins School of Medicine. GV Raymond is Associate Professor of Neurology at the Johns Hopkins School of Medicine and a neurologist at the Kennedy Krieger Institute.,

    Asif Mahmood & Gerald V Raymond

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Correspondence to Gerald V Raymond.

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Moser, H., Mahmood, A. & Raymond, G. X-linked adrenoleukodystrophy. Nat Rev Neurol 3, 140–151 (2007). https://doi.org/10.1038/ncpneuro0421

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