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Encephalopathy, neonatal severe, with lactic acidosis and brain abnormalities(NELABA; LIPT2D)

MedGen UID:
1624694
Concept ID:
C4540052
Disease or Syndrome
Synonym: LIPOYLTRANSFERASE 2 DEFICIENCY
 
Gene (location): LIPT2 (11q13.4)
 
Monarch Initiative: MONDO:0060562
OMIM®: 617668

Definition

NELABA is a severe autosomal recessive metabolic disorder characterized by onset at birth of progressive encephalopathy associated with increased serum lactate. Affected individuals have little or no psychomotor development and show brain abnormalities, including cerebral atrophy, cysts, and white matter abnormalities. Some patients die in infancy (summary by Habarou et al., 2017). [from OMIM]

Clinical features

From HPO
Feeding difficulties
MedGen UID:
65429
Concept ID:
C0232466
Finding
Impaired ability to eat related to problems gathering food and getting ready to suck, chew, or swallow it.
Dystonic disorder
MedGen UID:
3940
Concept ID:
C0013421
Sign or Symptom
An abnormally increased muscular tone that causes fixed abnormal postures. There is a slow, intermittent twisting motion that leads to exaggerated turning and posture of the extremities and trunk.
Seizure
MedGen UID:
20693
Concept ID:
C0036572
Sign or Symptom
A seizure is an intermittent abnormality of nervous system physiology characterized by a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.
Encephalopathy
MedGen UID:
39314
Concept ID:
C0085584
Disease or Syndrome
Encephalopathy is a term that means brain disease, damage, or malfunction. In general, encephalopathy is manifested by an altered mental state.
Global developmental delay
MedGen UID:
107838
Concept ID:
C0557874
Finding
A delay in the achievement of motor or mental milestones in the domains of development of a child, including motor skills, speech and language, cognitive skills, and social and emotional skills. This term should only be used to describe children younger than five years of age.
Spastic tetraparesis
MedGen UID:
658719
Concept ID:
C0575059
Disease or Syndrome
Spastic weakness affecting all four limbs.
Delayed gross motor development
MedGen UID:
332508
Concept ID:
C1837658
Finding
A type of motor delay characterized by a delay in acquiring the ability to control the large muscles of the body for walking, running, sitting, and crawling.
Periventricular cysts
MedGen UID:
326980
Concept ID:
C1839858
Finding
Absent speech
MedGen UID:
340737
Concept ID:
C1854882
Finding
Complete lack of development of speech and language abilities.
Lateral ventricle dilatation
MedGen UID:
383904
Concept ID:
C1856409
Pathologic Function
Simplified gyral pattern
MedGen UID:
413664
Concept ID:
C2749675
Finding
An abnormality of the cerebral cortex with fewer gyri but with normal cortical thickness. This pattern is usually often associated with congenital microcephaly.
Ventriculomegaly
MedGen UID:
480553
Concept ID:
C3278923
Finding
An increase in size of the ventricular system of the brain.
Profound global developmental delay
MedGen UID:
766364
Concept ID:
C3553450
Disease or Syndrome
A profound delay in the achievement of motor or mental milestones in the domains of development of a child.
Delayed CNS myelination
MedGen UID:
867393
Concept ID:
C4021758
Anatomical Abnormality
Delayed myelination in the central nervous system.
Elevated brain lactate level by MRS
MedGen UID:
868368
Concept ID:
C4022762
Finding
An increase in the level of lactate in the brain identified by magnetic resonance spectroscopy (MRS).
Absent posterior alpha rhythm
MedGen UID:
1612377
Concept ID:
C4531069
Finding
Lack of normal alpha rhythm in the EEG. Alpha rhythm has been defined as a rhythm at 8-13 Hz occurring during wakefulness over the posterior regions of the head, generally with higher voltage over the occipital areas. Amplitude is variable but is mostly below 50 microvolt in adults. It is best seen with eyes closed and under conditions of physical relaxation and relative mental inactivity. It is blocked or attenuated by attention, especially visual and mental effort. One should here note the difference between the terms alpha rhythm and alpha activity
Cerebral cortical atrophy
MedGen UID:
1646740
Concept ID:
C4551583
Disease or Syndrome
Atrophy of the cortex of the cerebrum.
Hypotonia
MedGen UID:
10133
Concept ID:
C0026827
Finding
Hypotonia is an abnormally low muscle tone (the amount of tension or resistance to movement in a muscle). Even when relaxed, muscles have a continuous and passive partial contraction which provides some resistance to passive stretching. Hypotonia thus manifests as diminished resistance to passive stretching. Hypotonia is not the same as muscle weakness, although the two conditions can co-exist.
Axial hypotonia
MedGen UID:
342959
Concept ID:
C1853743
Finding
Muscular hypotonia (abnormally low muscle tone) affecting the musculature of the trunk.
Microcephaly
MedGen UID:
1644158
Concept ID:
C4551563
Finding
Head circumference below 2 standard deviations below the mean for age and gender.
Respiratory insufficiency
MedGen UID:
11197
Concept ID:
C0035229
Pathologic Function
Impairment of gas exchange within the lungs secondary to a disease process, neoplasm, or trauma, possibly resulting in hypoxia, hypercarbia, or both, but not requiring intubation or mechanical ventilation. Patients are normally managed with pharmaceutical therapy, supplemental oxygen, or both.
Lactic acidosis
MedGen UID:
1717
Concept ID:
C0001125
Disease or Syndrome
An abnormal buildup of lactic acid in the body, leading to acidification of the blood and other bodily fluids.
Hyperglycinemia
MedGen UID:
82817
Concept ID:
C0268559
Disease or Syndrome
An elevated concentration of glycine in the blood.
Hyper-beta-alaninemia
MedGen UID:
75702
Concept ID:
C0268630
Disease or Syndrome
An increased concentration of alanine in the blood.
Increased circulating lactate concentration
MedGen UID:
332209
Concept ID:
C1836440
Finding
Abnormally increased level of blood lactate (2-hydroxypropanoic acid). Lactate is produced from pyruvate by lactate dehydrogenase during normal metabolism. The terms lactate and lactic acid are often used interchangeably but lactate (the component measured in blood) is strictly a weak base whereas lactic acid is the corresponding acid. Lactic acidosis is often used clinically to describe elevated lactate but should be reserved for cases where there is a corresponding acidosis (pH below 7.35).
Increased serum pyruvate
MedGen UID:
376596
Concept ID:
C1849488
Finding
An increased concentration of pyruvate in the blood.
Diminished alpha-ketoglutarate dehydrogenase activity in cultured fibroblasts
MedGen UID:
1053977
Concept ID:
CN377978
Finding
Concentration or activity of the alpha-ketoglutarate dehydrogenase complex as measured in cultured fibroblasts is below the limits of normal. This enzyme is a multienzyme complex consisting of 3 protein subunits, oxoglutarate dehydrogenase, also known as alpha-ketoglutarate dehydrogenase or E1k (EC 1.2.4.2.), dihydrolipoyl succinyltransferase (DLST, or E2k; 126063), and dihydrolipoyl dehydrogenase (DLD, or E3; 238331). The complex catalyzes a key reaction in the Krebs tricarboxylic acid cycle.

Professional guidelines

PubMed

DeBrosse SD, Okajima K, Zhang S, Nakouzi G, Schmotzer CL, Lusk-Kopp M, Frohnapfel MB, Grahame G, Kerr DS
Mol Genet Metab 2012 Nov;107(3):394-402. Epub 2012 Sep 7 doi: 10.1016/j.ymgme.2012.09.001. PMID: 23021068

Recent clinical studies

Etiology

Azzopardi D, Robertson NJ, Bainbridge A, Cady E, Charles-Edwards G, Deierl A, Fagiolo G, Franks NP, Griffiths J, Hajnal J, Juszczak E, Kapetanakis B, Linsell L, Maze M, Omar O, Strohm B, Tusor N, Edwards AD
Lancet Neurol 2016 Feb;15(2):145-153. Epub 2015 Dec 19 doi: 10.1016/S1474-4422(15)00347-6. PMID: 26708675Free PMC Article
DeBrosse SD, Okajima K, Zhang S, Nakouzi G, Schmotzer CL, Lusk-Kopp M, Frohnapfel MB, Grahame G, Kerr DS
Mol Genet Metab 2012 Nov;107(3):394-402. Epub 2012 Sep 7 doi: 10.1016/j.ymgme.2012.09.001. PMID: 23021068
Barnerias C, Saudubray JM, Touati G, De Lonlay P, Dulac O, Ponsot G, Marsac C, Brivet M, Desguerre I
Dev Med Child Neurol 2010 Feb;52(2):e1-9. Epub 2009 Dec 1 doi: 10.1111/j.1469-8749.2009.03541.x. PMID: 20002125
Murray DM, Boylan GB, Fitzgerald AP, Ryan CA, Murphy BP, Connolly S
Arch Dis Child Fetal Neonatal Ed 2008 May;93(3):F183-6. Epub 2006 Nov 28 doi: 10.1136/adc.2006.100800. PMID: 17132680
García-Cazorla A, Rabier D, Touati G, Chadefaux-Vekemans B, Marsac C, de Lonlay P, Saudubray JM
Ann Neurol 2006 Jan;59(1):121-7. doi: 10.1002/ana.20709. PMID: 16278852

Diagnosis

Saini N, Vijayasree V, Nandury EC, Dalal A, Aggarwal S
Prenat Diagn 2022 Dec;42(13):1682-1685. Epub 2022 Nov 26 doi: 10.1002/pd.6272. PMID: 36411461
Forny P, Hochuli M, Rahman Y, Deheragoda M, Weber A, Baruteau J, Grunewald S
J Inherit Metab Dis 2019 Sep;42(5):793-802. Epub 2019 Jul 17 doi: 10.1002/jimd.12143. PMID: 31260114
Pirot N, Crahes M, Adle-Biassette H, Soares A, Bucourt M, Boutron A, Carbillon L, Mignot C, Trestard L, Bekri S, Laquerrière A
J Neuropathol Exp Neurol 2016 Mar;75(3):227-38. Epub 2016 Feb 9 doi: 10.1093/jnen/nlv022. PMID: 26865159
De Meirleir L
Handb Clin Neurol 2013;113:1667-73. doi: 10.1016/B978-0-444-59565-2.00034-4. PMID: 23622387
Murray DM, Boylan GB, Fitzgerald AP, Ryan CA, Murphy BP, Connolly S
Arch Dis Child Fetal Neonatal Ed 2008 May;93(3):F183-6. Epub 2006 Nov 28 doi: 10.1136/adc.2006.100800. PMID: 17132680

Therapy

Azzopardi D, Robertson NJ, Bainbridge A, Cady E, Charles-Edwards G, Deierl A, Fagiolo G, Franks NP, Griffiths J, Hajnal J, Juszczak E, Kapetanakis B, Linsell L, Maze M, Omar O, Strohm B, Tusor N, Edwards AD
Lancet Neurol 2016 Feb;15(2):145-153. Epub 2015 Dec 19 doi: 10.1016/S1474-4422(15)00347-6. PMID: 26708675Free PMC Article
Barnerias C, Saudubray JM, Touati G, De Lonlay P, Dulac O, Ponsot G, Marsac C, Brivet M, Desguerre I
Dev Med Child Neurol 2010 Feb;52(2):e1-9. Epub 2009 Dec 1 doi: 10.1111/j.1469-8749.2009.03541.x. PMID: 20002125
Mochel F, DeLonlay P, Touati G, Brunengraber H, Kinman RP, Rabier D, Roe CR, Saudubray JM
Mol Genet Metab 2005 Apr;84(4):305-12. doi: 10.1016/j.ymgme.2004.09.007. PMID: 15781190

Prognosis

Forny P, Hochuli M, Rahman Y, Deheragoda M, Weber A, Baruteau J, Grunewald S
J Inherit Metab Dis 2019 Sep;42(5):793-802. Epub 2019 Jul 17 doi: 10.1002/jimd.12143. PMID: 31260114
Smith AC, Ito Y, Ahmed A, Schwartzentruber JA, Beaulieu CL, Aberg E, Majewski J, Bulman DE, Horsting-Wethly K, Koning DV; Care4Rare Canada Consortium, Rodenburg RJ, Boycott KM, Penney LS
J Inherit Metab Dis 2018 Jul;41(4):719-729. Epub 2018 Mar 20 doi: 10.1007/s10545-017-0122-7. PMID: 29560582
Baertling F, Haack TB, Rodenburg RJ, Schaper J, Seibt A, Strom TM, Meitinger T, Mayatepek E, Hadzik B, Selcan G, Prokisch H, Distelmaier F
Neurogenetics 2015 Jul;16(3):237-40. Epub 2015 Feb 10 doi: 10.1007/s10048-015-0440-6. PMID: 25663021
Morel AS, Joris N, Meuli R, Jacquemont S, Ballhausen D, Bonafé L, Fattet S, Tolsa JF
Eur J Pediatr 2009 Mar;168(3):311-5. Epub 2008 Jun 14 doi: 10.1007/s00431-008-0756-4. PMID: 18553104
Murray DM, Boylan GB, Fitzgerald AP, Ryan CA, Murphy BP, Connolly S
Arch Dis Child Fetal Neonatal Ed 2008 May;93(3):F183-6. Epub 2006 Nov 28 doi: 10.1136/adc.2006.100800. PMID: 17132680

Clinical prediction guides

Sabouny R, Wong R, Lee-Glover L, Greenway SC, Sinasac DS; Care4Rare Canada, Khan A, Shutt TE
Biochim Biophys Acta Mol Basis Dis 2019 Nov 1;1865(11):165536. Epub 2019 Aug 20 doi: 10.1016/j.bbadis.2019.165536. PMID: 31442532
Smith AC, Ito Y, Ahmed A, Schwartzentruber JA, Beaulieu CL, Aberg E, Majewski J, Bulman DE, Horsting-Wethly K, Koning DV; Care4Rare Canada Consortium, Rodenburg RJ, Boycott KM, Penney LS
J Inherit Metab Dis 2018 Jul;41(4):719-729. Epub 2018 Mar 20 doi: 10.1007/s10545-017-0122-7. PMID: 29560582
Azzopardi D, Robertson NJ, Bainbridge A, Cady E, Charles-Edwards G, Deierl A, Fagiolo G, Franks NP, Griffiths J, Hajnal J, Juszczak E, Kapetanakis B, Linsell L, Maze M, Omar O, Strohm B, Tusor N, Edwards AD
Lancet Neurol 2016 Feb;15(2):145-153. Epub 2015 Dec 19 doi: 10.1016/S1474-4422(15)00347-6. PMID: 26708675Free PMC Article
Murray DM, Boylan GB, Fitzgerald AP, Ryan CA, Murphy BP, Connolly S
Arch Dis Child Fetal Neonatal Ed 2008 May;93(3):F183-6. Epub 2006 Nov 28 doi: 10.1136/adc.2006.100800. PMID: 17132680
García-Cazorla A, Rabier D, Touati G, Chadefaux-Vekemans B, Marsac C, de Lonlay P, Saudubray JM
Ann Neurol 2006 Jan;59(1):121-7. doi: 10.1002/ana.20709. PMID: 16278852

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