Zellweger spectrum disorders: clinical overview and management approach

Femke C C Klouwer, Kevin Berendse, Sacha Ferdinandusse, Ronald J A Wanders, Marc Engelen, Bwee Tien Poll-The, Femke C C Klouwer, Kevin Berendse, Sacha Ferdinandusse, Ronald J A Wanders, Marc Engelen, Bwee Tien Poll-The

Abstract

Zellweger spectrum disorders (ZSDs) represent the major subgroup within the peroxisomal biogenesis disorders caused by defects in PEX genes. The Zellweger spectrum is a clinical and biochemical continuum which can roughly be divided into three clinical phenotypes. Patients can present in the neonatal period with severe symptoms or later in life during adolescence or adulthood with only minor features. A defect of functional peroxisomes results in several metabolic abnormalities, which in most cases can be detected in blood and urine. There is currently no curative therapy, but supportive care is available. This review focuses on the management of patients with a ZSD and provides recommendations for supportive therapeutic options for all those involved in the care for ZSD patients.

Figures

Fig. 1
Fig. 1
Schematic overview of main presenting symptoms in ZSDs per clinical group
Fig. 2
Fig. 2
Craniofacial dysmorphic features in ZSD patients developing over time a. Photograph of a 6-month-old girl with typical craniofacial dysmorphia. Note the epicantal folds, high forehead, broad nasal bridge and hypoplastic supraorbital ridges. The anterior fontanel is drawn and enlarged. b-c. Girl with a ZSD at the age of 9 months (b) and at the age of 1 year and two months (c). Less pronounced facial dysmorphism is present: a high forehead is seen, a broad nasal bridge, hypoplastic supraorbital ridges, anteverted nares and more subtle epicantal folds. d-f. Photograph of a male with a ZSD at the age of 5 years (d), 10 years (e) and 15 years (f). No evident facial dysmorphic features can be recognized, although the ears seem to be slightly low-set. Written informed consent was obtained from the parents of all patients for publication of these images
Fig. 3
Fig. 3
Diagnostic flow-chart for ZSDs. a Very long chain fatty acids: C26:0, C24:0/C22:0 ratio, C26:0/C22:0 ratio. b Single enzyme deficiency with phenotypical ZSD similarities like ACOX1 deficiency and DBP deficiency. c Next generation sequencing (NGS) of all PEX genes is advised when complementation analysis is not practicable

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