Mutations in the gene encoding peroxisomal α-methylacyl-CoA racemase cause adult-onset sensory motor neuropathy
Abstract
Sensory motor neuropathy is associated with various inherited disorders including Charcot-Marie-Tooth disease, X-linked adrenoleukodystrophy/adrenomyeloneuropathy and Refsum disease. In the latter two, the neuropathy is thought to result from the accumulation of specific fatty acids. We describe here three patients with elevated plasma concentrations of pristanic acid (a branched-chain fatty acid) and C27-bile-acid intermediates. Two of the patients suffered from adult-onset sensory motor neuropathy. One patient also had pigmentary retinopathy, suggesting Refsum disease, whereas the other patient had upper motor neuron signs in the legs, suggesting adrenomyeloneuropathy. The third patient was a child without neuropathy. In all three patients we discovered a deficiency of alpha-methylacyl-CoA racemase (AMACR). This enzyme is responsible for the conversion of pristanoyl-CoA and C27-bile acyl-CoAs to their (S)-stereoisomers, which are the only stereoisomers that can be degraded via peroxisomal beta-oxidation. Sequence analysis of AMACR cDNA from the patients identified two different mutations that are likely to cause disease, based on analysis in Escherichia coli. Our findings have implications for the diagnosis of adult-onset neuropathies of unknown aetiology.
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Pristanic acid and the bile acid intermediates DHCA and THCA, but not VLCFA, accumulate in AMACR-deficient patients.
“Accordingly, pristanic acid and the bile acid intermediates DHCA and THCA, but not VLCFA, accumulate in AMACR-deficient patients (Fig. 1) [93].”
From Peroxisomes in brain development and function (2016) · cites this paper as [93]
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- Authors
- Ferdinandusse, S., Denis, S., Clayton, P. T., Graham, A., Rees, J. E., Allen, J. T., McLean, B. N., Brown, A. Y., Vreken, P., Waterham, H. R., & Wanders, R. J. A.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- Princess Royal Hospital (GB)
- Southmead Hospital (GB)
- Royal Cornwall Hospital (GB)
- Corresponding author
- Wanders, Ronald J.A.
- Venue
- Nature Genetics
- Published
- 2000-02
- Volume
- 24
- Issue
- 2
- Pages
- 188-191
- ISSN
- 1061-4036 (ISSN-L)
- 1546-1718
- OpenAlex
- W1971365801
- Cited by
- 262
- References
- 23
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 13 · 2023: 6 · 2022: 6 · 2021: 8 · 2020: 11 · 2019: 5 · 2018: 10 · 2017: 10 · 2016: 6 · 2015: 6 · 2014: 14 · 2013: 13 · 2012: 9
- FWCI
- 4.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Nature Genetics (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Topics
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Hereditary Neurological Disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Metabolism and Genetic Disorders
- Life Sciences › Neuroscience › Neurology › Neurological diseases and metabolism
- Keywords
- AMACR, Refsum disease, adrenomyeloneuropathy, pristanic acid, branched-chain fatty acids, peroxisomal beta-oxidation, pigmentary retinopathy, Charcot-Marie-Tooth disease, upper motor neuron signs, peroxisomal disorders
- MeSH terms
- Adult, Amino Acid Sequence, Animals, Cloning, Molecular, Escherichia coli, Female, Humans, Infant, Male, Middle Aged, Molecular Sequence Data, Recombinant Proteins, Hereditary Sensory and Motor Neuropathy, Sequence Alignment, Point Mutation, Sequence Homology, Amino Acid, Age of Onset, Amino Acid Substitution, Racemases and Epimerases, Peroxisomes, Mice, Rats
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