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From the Developmental and Metabolic Neurology Branch (Drs. Altarescu, Sun, Moore, Wiggs, Frei, Gupta, Goldin, and Schiffmann, and C.R. Kaneski), Speech Language Pathology Section, Rehabilitation Medicine Department (B.I. Solomon), Diagnostic Radiology Department, Warren G. Magnuson Clinical Center (Dr. Patronas), and National Eye Institute (Dr. Smith), National Institutes of Health, Bethesda, MD; Harvard Institute of Human Genetics (Dr. Slaugenhaupt), Harvard Medical School, Boston, and Molecular Neurogenetics Unit, Massachusetts General Hospital, Charlestown, MA; and North Trent Genetics Service (Dr. Quarrell), Sheffield Childrens Hospital, UK.
Address correspondence and reprint requests to Dr. Raphael Schiffmann, National Institutes of Health, 9000 Rockville Pike, Bldg. 10, Rm. 3D03, Bethesda, MD 20892-1260; e-mail: rs4e{at}nih.gov
Background: Mucolipidosis type IV (MLIV) is an autosomal recessive disease caused by mutations in the MCOLN1 gene that codes for mucolipin, a member of the transient receptor potential (TRP) gene family.
Objective: To comprehensively characterize the clinical and genetic abnormalities of MLIV.
Methods: Twenty-eight patients with MLIV, aged 2 to 25 years, were studied. Ten returned for follow-up every 1 to 2 years for up to 5 years. Standard clinical, neuroimaging, neurophysiologic, and genetic techniques were used.
Results: All patients had varying degrees of corneal clouding, with progressive optic atrophy and retinal dystrophy. Twenty-three patients had severe motor and mental impairment. Motor function deteriorated in three patients and remained stable in the rest. All had a constitutive achlorhydria with elevated plasma gastrin level, and 12 had iron deficiency or anemia. Head MRI showed consistent characteristic findings of a thin corpus callosum and remained unchanged during the follow-up period. Prominent abnormalities of speech, hand usage, and swallowing were also noted. Mutations in the MCOLN1 gene were present in all patients. Correlation of the genotype with the neurologic handicap and corpus callosum dysplasia was found.
Conclusions: MLIV is both a developmental and a degenerative disorder. The presentation as a cerebral palsy-like encephalopathy may delay diagnosis.
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