Adrenoleukodystrophy: Survey of 303 cases: Biochemistry, diagnosis, and therapy

Hugo W. Moser, Ann E. Moser, Inderjit Singh, P. O'Neill

Research output: Contribution to journalArticle

Abstract

Adrenoleukodystrophy (ALD) is a genetically determined disorder associated with progressive central demyelination and adrenal cortical insufficiency. All affected persons show increased levels of saturated unbranched very‐long‐chain fatty acids, particularly hexacosanoate (C26:0), because of impaired capacity to degrade these acids. This degradation normally takes place in a subcellular organelle called the peroxisome, and ALD, together with Zellweger's cerebrohepatorenal syndrome, is now considered to belong to the newly formed category of peroxisomal disorders. Biochemical assays permit prenatal diagnosis, as well as identification of most heterozygotes. We have identified 303 patients with ALD in 217 kindreds. These patients show a wide phenotypic variation. Sixty percent of patients had childhood ALD and 17% adrenomyeloneuropathy, both of which are X‐linked, with the gene mapped to Xq28. Neonatal ALD, a distinct entity with autosomal recessive inheritance and points of resemblance to Zellweger's syndrome, accounted for 7% of the cases. Although excess C26:0 in the brain of patients with ALD is partially of dietary origin, dietary C26:0 restriction did not produce clear benefit. Bone marrow transplant lowered the plasma C26:0 level but failed to arrest neurological progression.

Original languageEnglish (US)
Pages (from-to)628-641
Number of pages14
JournalAnnals of neurology
Volume16
Issue number6
DOIs
StatePublished - Dec 1984

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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