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@ARTICLE{Beerepoot:280237,
author = {Beerepoot, Shanice and Schoenmakers, Daphne H and
Fumagalli, Francesca and Groeschel, Samuel and Schöls,
Ludger and Schiffmann, Raphael and Wong, Sheila and
Boespflug-Tanguy, Odile and Sevin, Caroline and Nadjar, Yann
and Bley, Annette and Mochel, Fanny and Horn, Morten A and
Baldoli, Cristina and Locatelli, Sara and Hengel, Holger and
Laugwitz, Lucia and Hollak, Carla E M and Gieselmann,
Volkmar and van der Knaap, Marjo S and Wolf, Nicole I},
title = {{ARSA} {V}ariants {A}ssociated {W}ith {C}ognitive {D}ecline
and {L}ong-{T}erm {P}reservation of {M}otor {F}unction in
{M}etachromatic {L}eukodystrophy.},
journal = {Journal of inherited metabolic disease},
volume = {48},
number = {5},
issn = {0141-8955},
address = {Hoboken, NJ},
publisher = {Wiley},
reportid = {DZNE-2025-00915},
pages = {e70072},
year = {2025},
abstract = {Patients with metachromatic leukodystrophy (MLD) show
variable motor and cognitive decline. The ARSA variants
c.256C>T, p.(Arg86Trp), c.257G>A, p.(Arg86Gln) and c.542T>G,
p.(Ile181Ser) are associated with predominantly cognitive
decline. This multinational study analyzed MLD onset type,
presenting signs/symptoms, cognitive function, gross motor
function, central motor tract involvement, MRI severity
score, peripheral neuropathy, and survival of 47 patients
(three homozygous for c.256C>T and five, twelve and 27
compound heterozygous for c.256C>T, c.257G>A, or c.542T>G
and another ARSA variant, respectively). Eleven underwent
hematopoietic stem cell transplantation (HSCT). Onset was
late-juvenile $(46.8\%)$ or adult $(44.7\%)$ with
predominantly cognitive decline (n = 40/41 symptomatic
patients). At diagnosis, untreated patients typically
retained independent walking $(100\%),$ sparing of central
motor tracts $(87.5\%),$ and absence of demyelinating
neuropathy $(95.5\%),$ which persisted in follow-up for most
$(76.5\%,$ $71.4\%,$ and $64.7\%,$ respectively).
Early-juvenile onset and rapid motor decline occurred only
in patients compound heterozygous for c.256C>T and a severe
second variant (n = 4), showing central motor tract
involvement at diagnosis. One untreated and one treated
patient died of disease progression, and another from HSCT
complications. All other treated patients retained
independent walking, and four of five tested normal
cognitive function. Median MRI severity score remained lower
in treated (13) than untreated patients (25). The phenotype
of c.256C>T carriers depends on the severity of the second
ARSA variant. Patients harboring c.257G>A or c.542T>G show
late-juvenile or adult onset with cognitive decline and
preserved motor function, usually associated with sparing of
central motor tracts. In these patients, cognitive function
and MRI severity score should be preferred treatment
outcomes.},
keywords = {Humans / Leukodystrophy, Metachromatic: genetics / Male /
Female / Adult / Cognitive Dysfunction: genetics /
Adolescent / Cerebroside-Sulfatase: genetics / Young Adult /
Child / Middle Aged / Magnetic Resonance Imaging / Child,
Preschool / Hematopoietic Stem Cell Transplantation /
Mutation / ARSA gene (Other) / arylsulfatase A (Other) /
genetic association studies (Other) / hematopoietic stem
cell transplantation (Other) / metachromatic leukodystrophy
(Other) / Cerebroside-Sulfatase (NLM Chemicals)},
cin = {AG Schöls},
ddc = {610},
cid = {I:(DE-2719)5000005},
pnm = {353 - Clinical and Health Care Research (POF4-353)},
pid = {G:(DE-HGF)POF4-353},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:40751594},
pmc = {pmc:PMC12317651},
doi = {10.1002/jimd.70072},
url = {https://pub.dzne.de/record/280237},
}