

「彼女は強さと威厳をまとっている
彼女は将来を恐れることなく笑う。」箴言31:25
中性脂質蓄積症ミオパチー(NLSD-M)
Neutral Lipid Storage Disease with Myopathy (NLSD-M)
November 26, 2023
NLSD-M is an ultra-rare genetic disease inherited in autosomal recessive fashion. This disease has a long history. Seventy years have passed since the first description of this disease by Professor Jordans in 1953. Symptoms of NLSD-M start at young and middle adult ages. Patients with NLSD-M suffer from slowly but irreversible and progressive disabling symptoms. No effective therapy is available. To find and develop therapies, this Non Profit Organization is launched.
In 2007, Professor Judith Fischer identified the genetic cause of NLSD-M as mutations in PNPLA2 gene, which encodes Adipose Triglyceride Lipase (ATGL). ATGL is an essential enzyme which break down triglyceride (TG) for mitochondrial b-oxidation to produce cellular energy. When both alleles of PNPLA2 are mutated, NLSD-M occurs. Patients’ muscles become fatty and lose power. As shown in Figure 1, there are no common mutations for NLSD-M found. A variety kind of mutations expanding the entire PNPLA2 gene have been identified (Figure 1), which makes it difficult to develop gene editing therapy.
So far, approximately ~100 patients with NLSD-M have been identified (Figure 2). Patients with NLSD-M are distributed globally. Italy and China have 20~50 patients. Japan has several. Other countries have a couple of patients.
One of the reasons why such a small number of patients have been identified is un-awareness or less information of this disease. Primary and even expert physicians or other medical professionals do not know this disease well. In fact, many patients with NLSD-M have been suffering from mis-, un-, and delayed diagnosis. It often takes a couple of decades for patients to receive proper diagnosis.
However, there is a big hit for the diagnosis in patients’ blood (Figure 3). Almost all neutrophils in patients with NLSD-M possess multiple cytoplasmic vacuoles of lipid called Jordans’ anomaly. This appears before the myopathy symptom is initiated. At a glance, physicians or medical professionals easily would note this abnormality. In addition, it has been reported that most hematology analyzers can theoretically detect Jordans’ anomaly.
I wish all patients with NLSD-M and their family members have hope, success, and a fruitful future. Please do not give up.
For more information, please see the following links as well:
https://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=en&Expert=98908
https://pubmed.ncbi.nlm.nih.gov/23333026/
https://jamanetwork.com/journals/jamaneurology/fullarticle/1150042
https://pmc.ncbi.nlm.nih.gov/articles/PMC9295162/
https://ojrd.biomedcentral.com/articles/10.1186/s13023-019-1209-z
https://pmc.ncbi.nlm.nih.gov/articles/PMC10134569/
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-024-07772-9
https://medlineplus.gov/genetics/condition/neutral-lipid-storage-disease-with-myopathy/
https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-023-03195-6
Global cooperation is highly appreciated.
Thank you very much.
Ken-ichi Hirano, MD, PhD
Department of Triglyceride Science, Graduate School of Medicine,
Osaka University, Osaka, Japan
Elena Pennisi, MD, PhD
Neuromuscular and Rare Neurological Disease Center, San Filipo Neri Hospital, Rome, Italy
Daisaku Nakatani, MD, PhD
Global Clinical Research Support Office, Department of Medical Innovation,
Osaka University Hospital, Osaka, Japan
Corrado Angelini, MD, PhD
Department of Neurosciences, Padova University Graduate School of Medicine, Padova, Italy

上の写真は症状が出る前の16歳。

NLSD-M に関する Ralph Macchio による正式な口頭声明。
