Project 2 Sjogren-Larsson syndrome (SLS) is a rare genetic disease caused by mutations in ALDH3A2 that encodes fatty aldehyde dehydrogenase (FALDH) and results in defective isoprenol oxidation and abnormal lipid metabolism. Patients typically exhibit ichthyosis, intellectual disability, spasticity, seizures and a distinctive maculopathy. Although the disease was described more than 50 years ago, longitudinal natural history studies of SLS are non-existent and the clinical spectrum of this rare disease is not yet established. The pathogenic mechanisms of the disease remain unclear and no specific pathogenesis-based therapy exists. Moreover, biomarkers that correlate with disease severity or progression have not been established. We will conduct a longitudinal natural history study of SLS to define long term changes in clinical phenotype and search for biomarkers that correlate with symptom severity and clinical disease. Subjects of all ages will be enrolled. Patients will receive detailed clinical exams documenting their neurologic, dermatologic and cognitive disabilities. Neurologic, ophthalmologic, dermatologic, and neuropsychiatric changes will be documented with MRI/MRS, EEG, optical coherence tomography, cutaneous photographs and neuropsychiatric testing. Blood, urine, skin and cutaneous scales will be investigated for potential biomarkers using lipidomics, proteomics and gene expression methods. Clinical and laboratory data will be correlated to identify useful biomarkers that predict disease severity and progression. A SLS Biorepository of blood (plasma, erythrocytes), urine, skin biopsies and keratinocyte cultures will be established for sharing with STAIR and outside investigators. When this study is completed, we expect to have a thorough knowledge of the natural history and clinical variation of SLS. The biomarkers that will be discovered from this research should serve as validated measures of disease for monitoring therapeutic trials.
This clinical investigation of SLS fits into the overall goals of STAIR and the RDCRN. It has relevance for understanding the natural history of this rare disease and implications for evaluating future therapy. lt is also relevant in a broader sense for understanding neurodevelopmental disabilities, myelin function and cutaneous disease.
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