Gaucher Disease

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Retrieved

2021-01-23

Source

Orphanet

Trials

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Genes

GBA, CHIT1, SNCA, ACE, CLN8, GBAP1, PSAP, UGCG, GBA2, SCARB2, GRN, CTNNB1, VDR, IL6, CHI3L1, TFEB, GBA3, ELF3, OGA, GPNMB, TNF, GLB1, CD1D, C5AR1, C5, HEXA, SMPD1, HAX1, GRAP2, HDAC9

GBA, CHIT1, SNCA, ACE, CLN8, GBAP1, PSAP, UGCG, GBA2, SCARB2, GRN, CTNNB1, VDR, IL6, CHI3L1, TFEB, GBA3, ELF3, OGA, GPNMB, TNF, GLB1, CD1D, C5AR1, C5, HEXA, SMPD1, HAX1, GRAP2, HDAC9, DCAF1, AHSA1, GDF15, ANGPT1, HSPB3, MGAM, NR1I2, RIPK1, AIMP2, NES, VEGFA, UGT1A, TTK, THBS3, TCP1, SPP1, SLC25A1, CXCR4, FGF21, RIPK3, UGT1A4, PLF, MIR155, MPEG1, CBLL2, PWAR1, RPAIN, ITCH, MUL1, SLC52A2, PINK1, HAMP, UGT1A3, UGT1A1, UGT1A9, MPRIP, UGT1A5, UGT1A6, UGT1A7, UGT1A8, UGT1A10, INPP5K, DNAJB11, FOXP3, LAMP3, CCL18, POLDIP2, RNF19A, ATP13A2, SI, PKLR, CCL3, CTSB, GJB2, GEM, GC, GALC, FCGR3B, FCGR3A, F9, F2R, EPO, DVL1, CTSS, CTSK, CTSD, MAPK14, CCL2, CRK, CCR5, CCR4, CFTR, CD63, CD34, CD14, CAMP, BTF3P11, BGLAP, ATR, ASPA, ARSA, GLA, HFE, AGFG1, HSPA4, RPS27, RNASE1, PSEN1, MAPK1, PPT1, APCS, PRKN, TNFRSF11B, NPC1, MTX1, MTHFR, MAN1A1, SH2D1A, LSAMP, LEP, LAMP1, KIR3DL1, ISLR, ISG20, IRF6, IL2RA, IGHG3, IGH, IDUA, HSP90AA1, HSPB2, HSPB1, APELA

Drugs

(1R,2R)-octanoic acid[2-(2',3'-dihydro-benzo[1,4] dioxin-6'-yl)-2-hydroxy-1-pyrrolidin-1-ylmethyl-ethyl]-amide-L-tartaric acid salt, Alglucerase ( CEREDASE ), Allogeneic multi-virus specific T lymphocytes targeting BK virus, cytomegalovirus, human herpesvirus-6, Epstein Barr virus and adenovirus, Eliglustat ( CERDELGA ), Imiglucerase ( CEREZYME ), Isofagomine tartrate, Miglustat ( MIGLUSTAT DIPHARMA, MIGLUSTAT GEN. ORPH, YARGESA, ZAVESCA ), Taliglucerase alfa ( ELELYSO ), Velaglucerase alfa ( VPRIV ), Venglustat, adeno-associated viral vector serotype 9 containing the human glucocerebrosidase gene, haematopoietic stem cells and blood progenitors umbilical cord-derived expanded with (1R, 4R)-N1-(2-benzyl-7-(2-methyl-2H-tetrazol-5-yl)-9H-pyrimido[4,5-b]indol-4-yl)cyclohexane-1,4-diamine dihydrobromide dihydrate

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Gaucher disease (GD) is a lysosomal storage disorder encompassing three main forms (types 1, 2 and 3), a fetal form and a variant with cardiac involvement (Gaucher disease - ophthalmoplegia - cardiovascular calcification or Gaucher-like disease).

Epidemiology

The prevalence is approximately 1/100,000. The annual incidence of GD in the general population is about 1/60,000, but it can reach up to 1/1,000 in Ashkenazi Jewish populations.

Clinical description

The clinical manifestations of this disease are highly variable. GD type 1 (90% of cases) is the chronic and non-neurological form associated with organomegaly (spleen, liver), bone anomalies (pain, osteonecrosis, pathological fractures) and cytopenia. Type 2, the acute neurological form, is characterized by early onset, rapidly progressing brainstem dysfunction, associated with organomegaly and leading to death before the age of 2. Type 3, the subacute neurological form, affects children or adolescents and is characterized by progressive encephalopathy (oculomotor apraxia, epilepsy and ataxia) with the systemic manifestations seen in type 1. The fetal form manifests with a decrease or absence of fetal movements or anasarca. Gaucher-like disease presents with progressive calcification of the aorta and the aortic and/ or mitral valves as its main feature.

Etiology

GD is due to mutations in the GBA gene (1q21) that codes for a lysosomal enzyme, glucocerebrosidase, or in very rare cases the PSAP gene that codes for its activator protein (saposin C). The deficiency in glucocerebrosidase leads to the accumulation of glucosylceramide (or beta-glucocerebrosidase) deposits in the cells of the reticuloendothelial system of the liver, the spleen and the bone marrow (Gaucher cells).

Diagnostic methods

Formal diagnosis of the disease is determined by the measurement of glucocerebrosidase levels in circulating leukocytes. Genotyping confirms the diagnosis.

Differential diagnosis

Differential diagnoses include other lysosomal storage disorders. The presence of Gaucher-like cells can be found in certain hematologic diseases (lymphoma, Hodgkin's lymphoma and chronic lymphocytic leukemia; see these terms).

Genetic counseling

Transmission is autosomal recessive.

Management and treatment

There are two available treatments for GD type 1 and 3: enzyme substitution therapy (using imiglucerase or velaglucerase) and substrate reduction therapy (miglustat). These treatments are ineffective for GD type 2.

Prognosis

The prognosis is good in GD type 1. In type 2, death usually occurs before the age of 2. Without specific treatment, GD type 3 progresses to death within a few years.