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Leukodystrophies with astrocytic dysfunction.
[alexander disease]
Astrocytic
dysfunctions
have
been
recently
identified
in
four
leukosdystrophies
without
peripheral
nervous
system
myelin
involvement
.
Alexander
disease
,
the
first
primary
genetic
astrocytic
disorder
identified
,
is
due
to
dominant
GFAP
mutations
.
The
presence
of
Rosenthal
fibers
throughout
the
CNS
is
the
pathological
hallmark
of
this
disease
.
Neurological
degradation
,
megalencephaly
,
and
typical
MRI
pattern
are
characteristic
of
infantile
sporadic
patients
.
Nevertheless
,
clinical
and
MRI
expression
is
large
,
including
late
onset
forms
which
can
be
familial
.
Spongiform
or
cystic
white
matter
CNS
degeneration
is
present
in
the
other
three
recessive
disorders
.
The
visualization
of
a
white
matter
cystic
breakdown
on
MRI
has
led
to
the
identification
of
CACH
/
VWM
and
MLC
diseases
.
CACH
/
VWM
is
due
to
mutations
in
one
of
the
five
subunits
of
EIF
2
B
which
compromise
the
astrocytic
lineage
.
The
clinical
spectrum
is
large
,
from
antenatal
to
adult
forms
,
and
several
extraneurological
organs
can
be
affected
.
Mutations
in
MLC
1
,
which
is
mainly
expressed
in
astrocyte
endfeet
,
produce
megalencephaly
,
whereas
the
mild
clinical
course
contrasts
with
severe
MRI
features
.
An
increased
concentration
of
NAA
in
the
urine
is
sufficient
to
diagnose
Canavan
disease
,
which
is
due
to
mutations
of
the
ASPA
gene
.
These
disorders
highlight
the
role
of
astrocytes
in
myelination
or
myelin
maintenance
.
Diseases
Validation
Diseases presenting
"dominant gfap mutations"
symptom
alexander disease
canavan disease
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