Cited by 321Metabolism and Genetic DisordersLysosomal Storage Disorders ResearchHereditary Neurological Disorders

The DOI matches its Crossref record; 85 of the 85 references it cites were found in a registry or an index; 12 of the 97 sources its claims cite were checked for support.

ABCD1 mutations and the X-linked adrenoleukodystrophy mutation database: Role in diagnosis and clinical correlations

Open access

Abstract

X-linked adrenoleukodystrophy (X-ALD) is caused by mutations in the ABCD1 gene, which encodes a peroxisomal ABC half-transporter (ALDP) involved in the import of very long-chain fatty acids (VLCFA) into the peroxisome. The disease is characterized by a striking and unpredictable variation in phenotypic expression. Phenotypes include the rapidly progressive childhood cerebral form (CCALD), the milder adult form, adrenomyeloneuropathy (AMN), and variants without neurologic involvement. There is no apparent correlation between genotype and phenotype. In males, unambiguous diagnosis can be achieved by demonstration of elevated levels of VLCFA in plasma. In 15 to 20% of obligate heterozygotes, however, test results are false-negative. Therefore, mutation analysis is the only reliable method for the identification of heterozygotes. Since most X-ALD kindreds have a unique mutation, a great number of mutations have been identified in the ABCD1 gene in the last seven years. In order to catalog and facilitate the analysis of these mutations, we have established a mutation database for X-ALD ( http://www.x-ald.nl). In this review we report a detailed analysis of all 406 X-ALD mutations currently included in the database. Also, we present 47 novel mutations. In addition, we review the various X-ALD phenotypes, the different diagnostic tools, and the need for extended family screening for the identification of new patients.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review catalogs 406 ABCD1 mutations in X-linked adrenoleukodystrophy as of June 2001, including 47 novel mutations, and synthesizes phenotype, diagnosis, and therapy. It emphasizes marked genotype-phenotype variability, with no clear mutation-phenotype correlation and mutation analysis needed for reliable heterozygote detection.

Key findings

  • The X-ALD mutation database contained 406 mutations: 227 (55.9%) missense, 110 (27.1%) frameshift, 37 (9.1%) nonsense, 16 (3.9%) small in-frame indels, and 16 (3.9%) large deletions; 234 (57.6%) were non-recurrent. The paper adds 47 novel unique mutations.
  • Mutations clustered in the transmembrane domain (40%), ATP-binding domain (30%), and exon 5 (14%); the 1415delAG hotspot accounted for 10.3% (42/406) of kindreds. ALDP was undetectable in 82.4% (178/216) of cell lines; among 52 unique missense mutations, 58% caused unstable/absent ALDP, 11% strongly reduced levels, and 31% no stability effect.
  • No apparent genotype-phenotype correlation was found: 1415delAG occurred across all phenotypes, and a P484R family had five phenotypes in six male patients. Plasma VLCFA testing gave false-negative results in approximately 20% of obligate heterozygotes; mutation analysis was the most reliable method for heterozygote identification.
  • Extended family screening of 4,169 at-risk relatives identified 594 additional hemizygotes (250 asymptomatic) and 1,270 heterozygotes; only 1.7% of hemizygotes had de novo mutations. ALDRP overexpression restored VLCFA β-oxidation in X-ALD fibroblasts, and transgenic mice showed 90% correction of VLCFA levels in brain and spinal cord up to eight months old.

Methods

  • Review and mutation-database analysis, not a primary cohort study. Data included all 406 ABCD1 mutations in the X-ALD database (www.x-ald.nl) as of June 2001, plus 47 novel mutations from Johns Hopkins/Kennedy Krieger/AMC.
  • Descriptive analyses cataloged mutation type, recurrence, exon/domain distribution, and ALDP expression/stability from 216 X-ALD cell lines; the review also synthesized published data on phenotypes, diagnosis, family screening, and therapy.
  • Mutation analysis strategy described by Boehm et al. used genomic DNA-based non-nested amplification of all coding exons and flanking intron-exon junctions in 10 amplicons; approximately 70% of mutations were identifiable in four amplicons covering 40% of the coding region.

Limitations

  • Stated: no apparent genotype-phenotype correlation and inability to predict clinical course from ABCD1 mutation or VLCFA levels; incidence estimates are minimums due to incomplete ascertainment; heterozygote frequency cannot be determined reliably by surveys; plasma VLCFA gives false negatives in 15–20% of obligate heterozygotes.
  • Stated: the physiological function of ALDP remains to be elucidated, and the relation between VLCS and ALDP is still elusive.
  • Evident from text: the mutation database is a June 2001 snapshot, so mutation counts and distributions may not reflect later discoveries; the review relies on published and database data rather than a systematic primary study.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1002/humu.1227

Cites

85 of 85 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

12 of 97 cited sources checked · 9 supported · 0 flagged · accuracy not yet measured

Show all 74 claims

  • Probably not a substantial claim. 38
  • It may state two separate claims as one. 42
71 of 71
  • The paper relies on this without support.

    In 15 to 20% of obligate X-ALD heterozygotes, plasma VLCFA test results are false-negative.

    “In 15 to 20% of obligate heterozygotes, however, test results are false-negative.”
  • The authors state this as an assumption.

    For calculating the ratio of female heterozygotes to hemizygous males, 37% of X-ALD hemizygotes fail to reach reproductive age and the reproductive fitness of heterozygotes is unimpaired.

    “Assuming that 37% of X-ALD hemizygotes (Fig. 1: the proportion who have the childhood cerebral phenotype [Bezman and Moser, 1998]) fail to reach reproductive age and that the reproductive fitness of heterozygotes is unimpaired”
  • The paper relies on this without support.

    In approximately 80% of patients with the childhood cerebral phenotype, MRI shows symmetrical demyelination in the parieto-occipital region, with contrast enhancement at the margin of the lesion.

    “In approximately 80% of patients with the childhood cerebral phenotype, MRI shows symmetrical demyelination in the parieto-occipital region, with contrast enhancement at the margin of the lesion.”
  • The paper relies on this without support.

    In approximately 15% of patients with the childhood cerebral phenotype, the initial lesion involves the frontal lobes.

    “In approximately 15% of these patients, the initial lesion involves the frontal lobes.”
  • The paper relies on this without support.

    Adrenal steroid replacement therapy corrects the adrenocortical insufficiency present in approximately 70% of male X-ALD patients.

    “Adrenal steroid replacement therapy corrects the adrenocortical insufficiency present in approximately 70% of male X-ALD patients.”
  • The paper relies on this without support.

    Approximately 75% of men with adult phenotypes of X-ALD show clinical or subclinical gonadal dysfunction.

    “Approximately 75% of men with adult phenotypes of X-ALD show clinical or subclinical gonadal dysfunction.”
  • The paper relies on this without support.

    BMT can delay or halt the inflammation that causes cerebral demyelination.

    “BMT can delay or halt the inflammation that causes cerebral demyelination.”
  • The paper relies on this without support.

    Test results of plasma VLCFA analysis are abnormal already on the day of birth.

    “Test results are abnormal already on the day of birth.”
  • The paper relies on this without support.

    The diagnosis of X-ALD in heterozygous women who do not have a known affected male relative is achieved only rarely.

    “The diagnosis of X-ALD in heterozygous women who do not have a known affected male relative is achieved only rarely and continues to represent a challenge.”
  • The paper relies on this without support.

    The most common clinical manifestation of X-ALD in heterozygous women is slowly progressive paraparesis.

    “The most common clinical manifestation is slowly progressive paraparesis, which may be difficult to differentiate from other conditions that can cause this, such as multiple sclerosis.”
  • The paper relies on this without support.

    Plasma VLCFA analysis is the most frequently used diagnostic test for X-ALD.

    “The plasma VLCFA analysis is the most frequently used diagnostic test for X-ALD.”
  • The paper relies on this without support.

    X-ALD is a serious and progressive disease.

    “X-ALD is a serious and progressive disease”
  • The paper relies on this without support.

    Neonatal screening for X-ALD is not yet feasible for technical reasons.

    “However, this approach is not yet feasible for technical reasons, several laboratories are exploring how neonatal screening can be accomplished.”
  • The paper relies on this without support.

    The mechanism by which BMT benefits X-ALD patients has not yet been defined.

    “The mechanism by which BMT benefits X-ALD patients has not yet been defined.”
  • The paper relies on this without support.

    At this time benefit of BMT has been observed only in patients who had cerebral involvement.

    “At this time benefit has been observed only in patients who had cerebral involvement.”
  • The paper relies on this without support.

    The impaired erectile function in AMN patients appears in most instances to be related to spinal cord involvement rather than endocrine insufficiency.

    “The impaired erectile function, which often occurs in AMN patients, appears in most instances to be related to spinal cord involvement rather than endocrine insufficiency.”
  • The paper relies on this without support.

    Gonadal mosaicism in X-ALD has never been reported and was never studied systematically.

    “Thus far it has never been reported, but on the other hand, it was never studied systematically.”
17 of 17

Claims other papers make about this one

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Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • C-terminal deletion is described as both 53 and 52 amino acids

    Minor

    A deletion spanning amino acids 693 through 745 includes 53 amino acids, not the stated 52.

1 of 1

Citations

Cites

Flagged first, then by citations

Research works printed but not linked: 7

  1. el Deiry, 1997, J Clin Endocrinol Metab, 82, 856
  2. Feigenbaum, 1996, Am J Hum Genet, 58, 1135
  3. Ligtenberg, 1995, Am J Hum Genet, 56, 44
  4. Melhem, 2000, AJNR Am J Neuroradiol, 21, 839
  5. 1995. The metabolic and molecular bases of inherited disease. 7th ed. New York: McGraw Hill.
  6. 2001. Single peroxisomal enzyme deficiences. In: editors. The metabolic and molecular bases of inherited disease. 8th ed. New York: McGraw Hill, Inc. p 3219-3256.
  7. Watkins, 1995, Am J Hum Genet, 57, 292

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Metadata

Authors
Kemp, S., Pujol, A., Waterham, H. R., van Geel, B. M., Boehm, C. D., Raymond, G. V., Cutting, G. R., Wanders, R. J. A., & Moser, H. W.
Affiliations
  • Amsterdam UMC Location University of Amsterdam (NL)
  • Institut de génétique et de biologie moléculaire et cellulaire (FR)
  • Johns Hopkins University (US)
  • Kennedy Krieger Institute (US)
Corresponding author
Kemp, Stephan
Venue
Human Mutation
Publisher
Wiley
Published
2001
Volume
18
Issue
6
Pages
499-515
ISSN
  • 1059-7794 (ISSN-L)
  • 1098-1004
OpenAlex
W2134676206
Cited by
321
References
83
Citations by year
2026: 17 · 2025: 14 · 2024: 16 · 2023: 11 · 2022: 22 · 2021: 14 · 2020: 10 · 2019: 14 · 2018: 9 · 2017: 13 · 2016: 13 · 2015: 10 · 2014: 16 · 2013: 14 · 2012: 15
FWCI
0.99
Type
journal article
Language
en
Open access
Locations
  • Human Mutation (publishedVersion)
  • PubMed (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • HAL (submittedVersion)
  • Pure Amsterdam UMC (submittedVersion)
Funders
  • U.S. Public Health Service
  • National Center for Research Resources (RR 000 52)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (P01HD010981)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Metabolism and Genetic Disorders
  • Health Sciences › Medicine › Genetics (clinical) › Lysosomal Storage Disorders Research
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Hereditary Neurological Disorders
Keywords
X-linked adrenoleukodystrophy, ABCD1 gene, ABCD1 mutations, mutation database, very long chain fatty acids, genotype-phenotype correlation, childhood cerebral adrenoleukodystrophy, adrenomyeloneuropathy, heterozygote identification, diagnostic testing
MeSH terms
ATP Binding Cassette Transporter, Subfamily D, Member 1, Adrenoleukodystrophy, Genotype, Humans, Mutation, Phenotype, ATP-Binding Cassette Transporters, Databases, Nucleic Acid

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