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Mucolipidosis type IV

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Overview

Mucolipidosis type IV (ML IV), like other types of mucolipidosis is an inherited neurodegenerative lysosomal storage disorder. Patients with this autosomal recessive disorder have symptoms including delayed psychomotor development and various ocular aberrations. This type of mucolipidosis is caused by mutation of a non-selective cation channel, TRPML1. These mutations disrupt lysosomal storage and lead to neurodegeneration through an unknown mechanism.

Historical Perspective

Historical Perspective

Classification

Classification

Pathophysiology

Pathophysiology

ML IV is caused by mutations in the cation channel TRPML1 (Mucolipin-1). TRPML1 is localized in endosomes and may function as either a proton leak channel and/or aid in the regulation of calcium levels. An important property of TRPML1 is that decreasing pH (acidification) results in deactivation of the protein, likely through an assembly defect. There are 10 mutations in TRPML1, located throughout the channel. Three of these mutations (Q79X, R102X and R172X) result in early truncation of the channels and the loss of functional protein. The other seven mutations result in either amino acid substitution or deletion. Of these, V446I and ΔF408 are known to be functional as channels. In these mutants, however, there is no acidification induced defect in assembly. These alterations result in the blockage of endocytic transport and prevention of lysosome formation. Over-acidification of these organelles may result in decreased lipase activity. This decreased lipase activity might then result in the increased levels of lipids and membraneous materials seen in patients. Alternatively, build-up of intra-compartmental calcium may prevent the fusion processes in these organelles.

Causes

Causes

Differentiating Mucolipidosis type IV from Other Diseases

Differentiating Mucolipidosis type IV from Other Diseases

Epidemiology and Demographics

Epidemiology and Demographics

Ashkenazi Jews have a high carrier frequency of 1:90 to 1:100.

Risk Factors

Risk Factors

Screening

Screening

Natural History, Complications, and Prognosis

Natural History, Complications, and Prognosis

Diagnosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Most patients with ML IV show psychomotor retardation (i.e., delayed development of movement and coordination), corneal opacity, retinal degeneration and other ophthalmological abnormalities. Other symptoms include agenesis of the corpus callosum, iron deficiency, and improper stomache pH (achlorohydria). Achlorhydria in these patients results in an increase in blood gastrin levels. These symptoms typically manifest early in life (within the first year) and progress slowly.

Physical Examination

Laboratory Findings

Imaging Findings

Other Diagnostic Studies

Treatment

Treatment

See the equivalent section in the main mucolipidosis article.

Medical Therapy

Surgery

Prevention

References

References

  • Nilius B, Owsianik G, Voets T, Peters JA (2007). “Transient receptor potential cation channels in disease”. Physiol. Rev. 87 (1): 165–217. doi:10.1152/physrev.00021.2006. PMID 17237345.

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