Onset of adreno-leukodystrophy after medulloblastoma therapy: Causal connection or coincidence?

G. Deib, A. Poretti, A. Meoded, K. J. Cohen, G. V. Raymond, M. Abromowitch, T. A.G.M. Huisman

Research output: Chapter in Book/Report/Conference proceedingChapter

1 Scopus citations

Abstract

X-linked adreno-leukodystrophy (ALD) is a peroxisomal disorder affecting the white matter of the central nervous system and the adrenal cortex. It is caused by mutations in the ABCD1 gene encoding for a peroxisomal membrane protein. The absent genotype–phenotype correlation implies a contribution by environmental factors to explain the phenotypical heterogeneity. We report on a 4-year-old boy with a biochemically confirmed diagnosis of ALD after birth. At the age of 32 months, the additional diagnosis of a medulloblastoma was made. After treatment of the medulloblastoma, he developed active areas of demyelination representing the characteristic neuroimaging features of ALD. The clinical history of our patient supports the hypothesis that external factors, like neurosurgical intervention as part of medulloblastoma treatment, may accelerate or initiate cerebral ALD-related demyelination. A postsurgical inflammatory reaction may facilitate the inclusion of abnormal fatty acids in myelin. The opening of the blood–brain barrier following neurosurgery may enhance the recognition of previously sequestered antigens considered to play a role in ALD onset. Consequently, neurosurgical disruption of the BBB can precipitate the immune-mediated inflammatory process, which progressively destroys myelin in ALD patients. Tumor-related chemotherapy and/or radiotherapy may also play a contributing role. We suggest that X-ALD patients who undergo neurosurgical intervention need close follow-up imaging to identify active demyelination early.

Original languageEnglish (US)
Title of host publicationJIMD Reports
PublisherSpringer
Pages29-32
Number of pages4
DOIs
StatePublished - 2012

Publication series

NameJIMD Reports
Volume2
ISSN (Print)2192-8304
ISSN (Electronic)2192-8312

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Biochemistry, Genetics and Molecular Biology (miscellaneous)

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    Deib, G., Poretti, A., Meoded, A., Cohen, K. J., Raymond, G. V., Abromowitch, M., & Huisman, T. A. G. M. (2012). Onset of adreno-leukodystrophy after medulloblastoma therapy: Causal connection or coincidence? In JIMD Reports (pp. 29-32). (JIMD Reports; Vol. 2). Springer. https://doi.org/10.1007/8904_2011_39