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Lysosomal leukodystrophies: Krabbe disease and metachromatic leukodystrophy.
[krabbe disease]
Genetic
deficiencies
of
lysosomal
catabolic
pathways
lead
to
storage
disorders
with
multiple
organ
abnormalities
or
to
degeneration
of
purely
nervous
structures
.
Krabbe
disease
and
metachromatic
leukodystrophy
are
caused
by
metabolic
errors
concerning
lipids
of
neural
membranes
.
They
are
characterized
by
demyelination
of
the
central
nervous
system
and
,
variably
,
the
peripheral
nerves
.
Their
clinical
presentation
is
a
relentlessly
progressive
motor
and
mental
deterioration
starting
at
any
age
between
infancy
and
adolescence
.
MRI
demonstrates
characteristic
lesions
of
brain
white
matter
.
In
Krabbe
disease
,
deficient
galactocerebroside
β-galactosidase
activity
causes
accumulation
of
lipids
in
"
globoid
"
macrophages
and
of
psychosine
,
which
is
toxic
to
oligodendrocytes
.
Diagnosis
depends
on
demonstration
of
the
enzyme
deficiency
.
Experimental
treatment
is
limited
to
hematopoietic
stem
cell
transplantation
,
which
can
favorably
alter
the
course
of
disease
in
certain
situations
.
In
metachromatic
leukodystrophy
,
deficient
activity
of
arylsulfatase
A
,
or
lack
of
a
cofactor
,
causes
accumulation
of
sulfatide
in
various
tissues
and
diffuse
demyelination
.
Symptoms
are
neurological
,
but
gallbladder
dysfunction
may
be
present
.
Diagnosis
depends
on
demonstrating
the
enzyme
deficiency
and
elevated
urinary
sulfatide
.
In
a
rare
variant
,
multiple
sulfatases
are
deficient
.
Stem
cell
transplantation
may
prevent
disease
progression
in
selected
cases
.
Enzyme
replacement
is
being
evaluated
,
and
gene
therapies
are
being
developed
.
Diseases
Validation
Diseases presenting
"causes accumulation of sulfatide in various tissues and diffuse demyelination"
symptom
krabbe disease
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