Newborn Screening for Adrenoleukodystrophy
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GENETIC DISORDERS
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Newborn Screening for Adrenoleukodystrophy Implications for Therapy Gerald V. Raymond, Richard O. Jones and Ann B. Moser Neurogenetics, Kennedy Krieger Institute, Baltimore, Maryland, USA
Contents Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381 1. Clinical Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381 2. Present Therapies for X-Linked Adrenoleukodystrophy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 382 3. Rationale for Earlier Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 382 4. Development of a Methodology for Newborn Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383 5. Discussion of Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
Abstract
X-Linked adrenoleukodystrophy (X-ALD) is a progressive metabolic condition affecting the adrenal glands and nervous system of males. Although variable in the age of onset and presentation in families, X-ALD does present in characteristic phenotypes including a devastating childhood form that affects 35% of boys with this genetic condition. The majority of males with X-ALD will also develop adrenal insufficiency, which may result in crisis. Early detection is desirable in order to prevent morbidity from this condition. We have recently developed a tandem mass spectroscopy method that allows this to be done during newborn screening for other genetic disorder. In this review, we discuss the rationale for early detection, its effect on treatment, and some of the uncertainties.
X-Linked adrenoleukodystrophy (X-ALD) is a progressive genetic condition affecting the nervous system and adrenal glands. With an incidence of 1 : 17 000, it is the most common disorder involving the peroxisome. Individuals with this condition have an elevation of saturated very long chain fatty acids (VLCFA) in all body tissue, including fibroblasts and plasma. This accumulation of VLCFA, especially hexacosanoic acid (C26:0), has become widely utilized in the evaluation of peroxisomal disorders and has been diagnostic in thousands of individuals.[1] X-ALD has subsequently been shown to be caused by defects of the ABCD1 gene located on the long arm of the X chromosome, which codes for a peroxisomal membrane protein that is a me
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