Aicardi-Goutières syndrome may present with positive newborn screen for X-linked adrenoleukodystrophy
Christina G Tise1, Jose Andres Morales1, Ariel S Lee2
1Division of Medical Genetics, Department of Pediatrics, Lucile Packard Children's Hospital and Stanford University, Stanford, California, USA.
Insights
Aicardi-Goutières syndrome (AGS) can be mistaken for X-linked adrenoleukodystrophy (X-ALD) in newborns. Early identification of AGS through newborn screening (NBS) is crucial for timely intervention and potential clinical trial enrollment.
Area of Science:
- Genetics
- Biochemistry
- Neurology
Background:
- Newborn screening (NBS) programs are vital for early detection of genetic disorders.
- X-linked adrenoleukodystrophy (X-ALD) is screened for using elevated C26:0 lysophosphatidylcholine (C26:0-LPC).
- Aicardi-Goutières syndrome (AGS) is a rare genetic disorder that can present with overlapping symptoms.
Abstract:
We report three unrelated probands, two male and one female, diagnosed with Aicardi-Goutières syndrome (AGS) after screening positive on California newborn screening (CA NBS) for X-linked adrenoleukodystrophy (X-ALD) due to elevated C26:0 lysophosphatidylcholine (C26:0-LPC). Follow-up evaluation was notable for elevated C26:0, C26:1, and C26:0/C22:0 ratio, and normal red blood cell plasmalogens levels in all three probands. Diagnoses were confirmed by molecular sequencing prior to 12 months of age after clinical evaluation was inconsistent with X-ALD or suggestive of AGS. For at least one proband, the early diagnosis of AGS enabled candidacy for enrollment into a therapeutic clinical trial. This report demonstrates the importance of including AGS on the differential diagnosis for individuals who screen positive for X-ALD, particularly infants with abnormal neurological features, as this age of onset would be highly unusual for X-ALD. While AGS is not included on the Recommended Universal Screening Panel, affected individuals can be identified early through state NBS programs so long as providers are aware of a broader differential that includes AGS. This report is timely, as state NBS algorithms for X-ALD are actively being established, implemented, and refined.
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