Semin Neurol 2014; 34(03): 312-320
DOI: 10.1055/s-0034-1386769
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Leukodystrophies

Hannah B. Gordon
1   Department of Human Genetics, University of Utah School of Medicine, Salt Lake City, Utah
,
Anthea Letsou
1   Department of Human Genetics, University of Utah School of Medicine, Salt Lake City, Utah
,
Joshua L. Bonkowsky
2   Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
3   Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah
› Author Affiliations
Further Information

Publication History

Publication Date:
05 September 2014 (online)

Abstract

Leukodystrophies are a group of genetically determined disorders that affect development or maintenance of central nervous system myelin. Leukodystrophies have a reported incidence of 1 in 7500 live births, but fewer than half of patients receive a specific diagnosis. In this review, the authors discuss types of leukodystrophies: their prevalence, clinical presentation, symptoms, and diagnosis, as well as current and future treatments. Diagnosis is based on a combination of history, exam, radiological, and laboratory findings, including genetic testing. Leukodystrophies can present at any age from infancy to adulthood, with variability in disease progression and clinical presentation, ranging from developmental delay to seizures to spasticity. Although there are few cures, there are significant opportunities for care and improvements in patient well-being. Their high prevalence, combined with rapid advances in imaging, genetics, and potential treatments, makes an understanding of the leukodystrophies necessary for care providers in genetics and neurology.

 
  • References

  • 1 Bielschowsky M, Henneberg R. Ueber familiaere diffuse Sklerose (Leukodystrophia cerebri progressiva hereditaria). J Psychol Neurol 1928; 36: 131-181
  • 2 Kaye EM. Update on genetic disorders affecting white matter. Pediatr Neurol 2001; 24 (1) 11-24
  • 3 Maria BL, Deidrick KM, Moser H, Naidu S. Leukodystrophies: pathogenesis, diagnosis, strategies, therapies, and future research directions. J Child Neurol 2003; 18 (9) 578-590
  • 4 Kohlschütter A, Bley A, Brockmann K , et al. Leukodystrophies and other genetic metabolic leukoencephalopathies in children and adults. Brain Dev 2010; 32 (2) 82-89
  • 5 Bonkowsky JL, Nelson C, Kingston JL, Filloux FM, Mundorff MB, Srivastava R. The burden of inherited leukodystrophies in children. Neurology 2010; 75 (8) 718-725
  • 6 Schiffmann R, van der Knaap MS. Invited article: an MRI-based approach to the diagnosis of white matter disorders. Neurology 2009; 72 (8) 750-759
  • 7 Nave KA. Myelination and support of axonal integrity by glia. Nature 2010; 468 (7321) 244-252
  • 8 Savas JN, Toyama BH, Xu T, Yates III JR, Hetzer MW. Extremely long-lived nuclear pore proteins in the rat brain. Science 2012; 335 (6071) 942
  • 9 Kang SH, Fukaya M, Yang JK, Rothstein JD, Bergles DE. NG2+ CNS glial progenitors remain committed to the oligodendrocyte lineage in postnatal life and following neurodegeneration. Neuron 2010; 68 (4) 668-681
  • 10 Baumann N, Pham-Dinh D. Biology of oligodendrocyte and myelin in the mammalian central nervous system. Physiol Rev 2001; 81 (2) 871-927
  • 11 Jahn O, Tenzer S, Werner HB. Myelin proteomics: molecular anatomy of an insulating sheath. Mol Neurobiol 2009; 40 (1) 55-72
  • 12 Aggarwal S, Yurlova L, Simons M. Central nervous system myelin: structure, synthesis and assembly. Trends Cell Biol 2011; 21 (10) 585-593
  • 13 White R, Krämer-Albers EM. Axon-glia interaction and membrane traffic in myelin formation. Front Cell Neurosci 2014; 7: 284
  • 14 de Castro F, Bribián A, Ortega MC. Regulation of oligodendrocyte precursor migration during development, in adulthood and in pathology. Cell Mol Life Sci 2013; 70 (22) 4355-4368
  • 15 Wake H, Lee PR, Fields RD. Control of local protein synthesis and initial events in myelination by action potentials. Science 2011; 333 (6049) 1647-1651
  • 16 Bartzokis G, Beckson M, Lu PH, Nuechterlein KH, Edwards N, Mintz J. Age-related changes in frontal and temporal lobe volumes in men: a magnetic resonance imaging study. Arch Gen Psychiatry 2001; 58 (5) 461-465
  • 17 van der Knaap MS, Pronk JC, Scheper GC. Vanishing white matter disease. Lancet Neurol 2006; 5 (5) 413-423
  • 18 Berger J, Forss-Petter S, Eichler FS. Pathophysiology of X-linked adrenoleukodystrophy. Biochimie 2014; 98: 135-142
  • 19 Vanderver A, Hussey H, Schmidt JL, Pastor W, Hoffman HJ. Relative incidence of inherited white matter disorders in childhood to acquired pediatric demyelinating disorders. Semin Pediatr Neurol 2012; 19 (4) 219-223
  • 20 van der Knaap MS, Breiter SN, Naidu S, Hart AA, Valk J. Defining and categorizing leukoencephalopathies of unknown origin: MR imaging approach. Radiology 1999; 213 (1) 121-133
  • 21 Pfeifenbring S, von Baumgarten L, Schüller U , et al. Biopsy findings of symptomatic cerebral X-linked adrenoleukodystrophy and histological differentiation from multiple sclerosis. Neuropathol Appl Neurobiol 2014; 40 (5) 658-661
  • 22 Baronica KB, Mlinac K, Ozretić D, Vladić A, Bognar SK. Arylsulfatase a gene polymorphisms in relapsing remitting multiple sclerosis: genotype-phenotype correlation and estimation of disease progression. Coll Antropol 2011; 35 (Suppl. 01) 11-16
  • 23 Eichler F, Van Haren K. Immune response in leukodystrophies. Pediatr Neurol 2007; 37 (4) 235-244
  • 24 Feenstra I, Vissers LE, Orsel M , et al. Genotype-phenotype mapping of chromosome 18q deletions by high-resolution array CGH: an update of the phenotypic map. Am J Med Genet A 2007; 143A (16) 1858-1867
  • 25 Horn MA, Retterstøl L, Abdelnoor M, Skjeldal OH, Tallaksen CM. Adrenoleukodystrophy in Norway: high rate of de novo mutations and age-dependent penetrance. Pediatr Neurol 2013; 48 (3) 212-219
  • 26 Ługowska A, Ponińska J, Krajewski P, Broda G, Płoski R. Population carrier rates of pathogenic ARSA gene mutations: is metachromatic leukodystrophy underdiagnosed?. PLoS ONE 2011; 6 (6) e20218
  • 27 Heim P, Claussen M, Hoffmann B , et al. Leukodystrophy incidence in Germany. Am J Med Genet 1997; 71 (4) 475-478
  • 28 Sereni C, Paturneau-Jouas M, Aubourg P, Baumann N, Feingold J. Adrenoleukodystrophy in France: an epidemiological study. Neuroepidemiology 1993; 12 (4) 229-233
  • 29 Kirk EP, Fletcher JM, Sharp P, Carey B, Poulos A. X-linked adrenoleukodystrophy: the Australasian experience. Am J Med Genet 1998; 76 (5) 420-423
  • 30 Takemoto Y, Suzuki Y, Tamakoshi A , et al. Epidemiology of X-linked adrenoleukodystrophy in Japan. J Hum Genet 2002; 47 (11) 590-593
  • 31 Steenweg ME, Vanderver A, Blaser S , et al. Magnetic resonance imaging pattern recognition in hypomyelinating disorders. Brain 2010; 133 (10) 2971-2982
  • 32 La Piana R, Tonduti D, Gordish Dressman H , et al. Brain magnetic resonance imaging (MRI) pattern recognition in Pol III-related leukodystrophies. J Child Neurol 2014; 29 (2) 214-220
  • 33 Yang E, Prabhu SP. Imaging manifestations of the leukodystrophies, inherited disorders of white matter. Radiol Clin North Am 2014; 52 (2) 279-319
  • 34 van der Knaap MS, Ramesh V, Schiffmann R , et al. Alexander disease: ventricular garlands and abnormalities of the medulla and spinal cord. Neurology 2006; 66 (4) 494-498
  • 35 Welker KM, Patton A. Assessment of normal myelination with magnetic resonance imaging. Semin Neurol 2012; 32 (1) 15-28
  • 36 van der Knaap MS, Valk J, Bakker CJ , et al. Myelination as an expression of the functional maturity of the brain. Dev Med Child Neurol 1991; 33 (10) 849-857
  • 37 Pujol J, López-Sala A, Sebastián-Gallés N , et al. Delayed myelination in children with developmental delay detected by volumetric MRI. Neuroimage 2004; 22 (2) 897-903
  • 38 Yang Y, Muzny DM, Reid JG , et al. Clinical whole-exome sequencing for the diagnosis of mendelian disorders. N Engl J Med 2013; 369 (16) 1502-1511
  • 39 Raymond GV, Jones RO, Moser AB. Newborn screening for adrenoleukodystrophy: implications for therapy. Mol Diagn Ther 2007; 11 (6) 381-384
  • 40 Orsini JJ, Martin MM, Showers AL , et al. Lysosomal storage disorder 4+1 multiplex assay for newborn screening using tandem mass spectrometry: application to a small-scale population study for five lysosomal storage disorders. Clin Chim Acta 2012; 413 (15-16) 1270-1273
  • 41 Duffner PK, Caggana M, Orsini JJ , et al. Newborn screening for Krabbe disease: the New York State model. Pediatr Neurol 2009; 40 (4) 245-252 , discussion 253–255
  • 42 Orsini JJ, Morrissey MA, Slavin LN , et al. Implementation of newborn screening for Krabbe disease: population study and cutoff determination. Clin Biochem 2009; 42 (9) 877-884
  • 43 Waggoner DJ, Tan CA. Expanding newborn screening for lysosomal disorders: opportunities and challenges. Dev Disabil Res Rev 2011; 17 (1) 9-14
  • 44 Lantos JD. Dangerous and expensive screening and treatment for rare childhood diseases: the case of Krabbe disease. Dev Disabil Res Rev 2011; 17 (1) 15-18
  • 45 Nakamura K, Hattori K, Endo F. Newborn screening for lysosomal storage disorders. Am J Med Genet C Semin Med Genet 2011; 157C (1) 63-71
  • 46 Boelens JJ. Trends in haematopoietic cell transplantation for inborn errors of metabolism. J Inherit Metab Dis 2006; 29 (2-3) 413-420
  • 47 Sevin C, Aubourg P, Cartier N. Enzyme, cell and gene-based therapies for metachromatic leukodystrophy. J Inherit Metab Dis 2007; 30 (2) 175-183
  • 48 Orchard PJ, Tolar J. Transplant outcomes in leukodystrophies. Semin Hematol 2010; 47 (1) 70-78
  • 49 Escolar ML, Poe MD, Provenzale JM , et al. Transplantation of umbilical-cord blood in babies with infantile Krabbe's disease. N Engl J Med 2005; 352 (20) 2069-2081
  • 50 Martin PL, Carter SL, Kernan NA , et al. Results of the cord blood transplantation study (COBLT): outcomes of unrelated donor umbilical cord blood transplantation in pediatric patients with lysosomal and peroxisomal storage diseases. Biol Blood Marrow Transplant 2006; 12 (2) 184-194
  • 51 Valayannopoulos V. Enzyme replacement therapy and substrate reduction therapy in lysosomal storage disorders with neurological expression. Handb Clin Neurol 2013; 113: 1851-1857
  • 52 Stroobants S, Gerlach D, Matthes F , et al. Intracerebroventricular enzyme infusion corrects central nervous system pathology and dysfunction in a mouse model of metachromatic leukodystrophy. Hum Mol Genet 2011; 20 (14) 2760-2769
  • 53 Moser HW, Raymond GV, Lu SE , et al. Follow-up of 89 asymptomatic patients with adrenoleukodystrophy treated with Lorenzo's oil. Arch Neurol 2005; 62 (7) 1073-1080
  • 54 Aubourg P, Adamsbaum C, Lavallard-Rousseau MC , et al. A two-year trial of oleic and erucic acids (“Lorenzo's oil”) as treatment for adrenomyeloneuropathy. N Engl J Med 1993; 329 (11) 745-752
  • 55 Moser HW, Moser AB, Hollandsworth K, Brereton NH, Raymond GV. “Lorenzo's oil” therapy for X-linked adrenoleukodystrophy: rationale and current assessment of efficacy. J Mol Neurosci 2007; 33 (1) 105-113
  • 56 Berger J, Pujol A, Aubourg P, Forss-Petter S. Current and future pharmacological treatment strategies in X-linked adrenoleukodystrophy. Brain Pathol 2010; 20 (4) 845-856
  • 57 Van Haren K, Bonkowsky JL, Bernard G , et al , on behalf of the GLIA Consortium. Consensus statement on preventive and symptomatic care of leukodystrophy patients. Mol Genet Metab 2014; ; In press
  • 58 Cohen-Cymberknoh M, Shoseyov D, Kerem E. Managing cystic fibrosis: strategies that increase life expectancy and improve quality of life. Am J Respir Crit Care Med 2011; 183 (11) 1463-1471
  • 59 Brimley CJ, Lopez J, van Haren K , et al. National variation in costs and mortality for leukodystrophy patients in US children's hospitals. Pediatr Neurol 2013; 49 (3) 156-162 , e1
  • 60 Barrell C. Juvenile metachromatic leukodystrophy: understanding the disease and implications for nursing care. J Pediatr Oncol Nurs 2007; 24 (2) 64-69
  • 61 Holmes L, Cornes MJ, Foldi B, Miller F, Dabney K. Clinical epidemiologic characterization of orthopaedic and neurological manifestations in children with leukodystrophies. J Pediatr Orthop 2011; 31 (5) 587-593
  • 62 Nelson C, Mundorff MB, Korgenski EK, Brimley CJ, Srivastava R, Bonkowsky JL. Determinants of health care use in a population-based leukodystrophy cohort. J Pediatr 2013; 162 (3) 624-628 , e1
  • 63 Anderson HM, Wilkes J, Korgenski EK , et al. Preventable infections in children with leukodystrophy. Ann Clin Transl Neurol 2014; 1 (5) 370-374
  • 64 Lu JF, Lawler AM, Watkins PA , et al. A mouse model for X-linked adrenoleukodystrophy. Proc Natl Acad Sci U S A 1997; 94 (17) 9366-9371
  • 65 Kobayashi T, Shinnoh N, Kondo A, Yamada T. Adrenoleukodystrophy protein-deficient mice represent abnormality of very long chain fatty acid metabolism. Biochem Biophys Res Commun 1997; 232 (3) 631-636
  • 66 Forss-Petter S, Werner H, Berger J , et al. Targeted inactivation of the X-linked adrenoleukodystrophy gene in mice. J Neurosci Res 1997; 50 (5) 829-843
  • 67 Morató L, Galino J, Ruiz M , et al. Pioglitazone halts axonal degeneration in a mouse model of X-linked adrenoleukodystrophy. Brain 2013; 136 (Pt 8) 2432-2443
  • 68 Min KT, Benzer S. Preventing neurodegeneration in the Drosophila mutant bubblegum. Science 1999; 284 (5422) 1985-1988
  • 69 Hagemann TL, Connor JX, Messing A. Alexander disease-associated glial fibrillary acidic protein mutations in mice induce Rosenthal fiber formation and a white matter stress response. J Neurosci 2006; 26 (43) 11162-11173
  • 70 Wang L, Colodner KJ, Feany MB. Protein misfolding and oxidative stress promote glial-mediated neurodegeneration in an Alexander disease model. J Neurosci 2011; 31 (8) 2868-2877
  • 71 Koç ON, Day J, Nieder M, Gerson SL, Lazarus HM, Krivit W. Allogeneic mesenchymal stem cell infusion for treatment of metachromatic leukodystrophy (MLD) and Hurler syndrome (MPS-IH). Bone Marrow Transplant 2002; 30 (4) 215-222
  • 72 Biffi A, Montini E, Lorioli L , et al. Lentiviral hematopoietic stem cell gene therapy benefits metachromatic leukodystrophy. Science 2013; 341 (6148) 1233158
  • 73 Cartier N, Hacein-Bey-Abina S, Bartholomae CC , et al. Hematopoietic stem cell gene therapy with a lentiviral vector in X-linked adrenoleukodystrophy. Science 2009; 326 (5954) 818-823
  • 74 Saher G, Rudolphi F, Corthals K , et al. Therapy of Pelizaeus-Merzbacher disease in mice by feeding a cholesterol-enriched diet. Nat Med 2012; 18 (7) 1130-1135
  • 75 Németh AH, Kwasniewska AC, Lise S , et al; UK Ataxia Consortium. Next generation sequencing for molecular diagnosis of neurological disorders using ataxias as a model. Brain 2013; 136 (Pt 10) 3106-3118
  • 76 Purnell SM, Bleyl SB, Bonkowsky JL. Clinical exome sequencing identifies a novel TUBB4A mutation in a child with static hypomyelinating leukodystrophy. Pediatr Neurol 2014; 50 (6) 608-611
  • 77 Jalal K, Carter R, Yan L, Barczykowski A, Duffner PK. Does galactocerebrosidase activity predict Krabbe phenotype?. Pediatr Neurol 2012; 47 (5) 324-329
  • 78 May T, Zusevics KL, Strong KA. On the ethics of clinical whole genome sequencing of children. Pediatrics 2013; 132 (2) 207-209
  • 79 Knoppers BM, Sénécal K, Borry P, Avard D. Whole-genome sequencing in newborn screening programs. Sci Transl Med 2014; 6 (229) cm2